Irini Lekka

The citizen health system (CHS): a Modular medical contact center providing quality telemedicine services

In the context of the Citizen Health System (CHS) project, a modular Medical Contact Center (MCC) was developed, which can be used in the monitoring, treatment, and management of chronically ill patients at home, such as diabetic or congestive heart failure patients. The virtue of the CHS contact center is that, using any type of communication and telematics technology, it is able to provide timely and preventive prompting to the patients, thus, achieving better disease management. In this paper, we present the structure of the CHS system, describing the modules that enable its flexible and extensible architecture. It is shown, through specific examples, how quality of healthcare delivery can be increased by using such a system.

Effectiveness of home-centered care through telemedicine applications for overweight and obese patients: a randomized controlled trial.

OBJECTIVE: To determine if home-centered monitoring through telemedicine has an impact on clinical characteristics, metabolic profile and quality of life in overweight and obese patients.DESIGN: Randomized controlled trial, 6-month duration.SETTING: Tertiary care academic hospital.SUBJECTS: A total of 122 patients were eligible to participate as they met the inclusion criteria of increased body mass index (BMI>25 kg/m2), age>18 and <70 y and ability to operate electronic microdevices.INTERVENTIONS: All patients in the control group (n=77) received standard hospital care. Patients in the intervention group (n=45), additionally, measured three times a week, for 6 months, their blood pressure and body weight and transmitted them to an automated call center. These values were not shared with the patients’ physician or dietician.MAIN OUTCOME MEASURES: Clinical (body weight, BMI, blood pressure), laboratory (fasting plasma glucose, triglycerides, HDL-cholesterol, total cholesterol) and quality of life parameters (SF-36®, Visual Analog Scale of European Quality-5 Dimensions, Obesity Assessment Survey). Data were analyzed in an intention-to-treat-way (last observation carried forward).RESULTS: Drop-out rate was similar in the control and intervention groups: 12 vs 11 percent, respectively, P=NS. There were no significant differences at baseline between intervention and control groups in all main outcome parameters. There were significant decreases for patients in the intervention group in body weight (from 101.6±22.4 to 89.2±14.7 kg, P=0.002, P=0.05 vs controls at 6 months), total cholesterol (from 247.6±42.0 to 220.7±42.6 mg/dl, P=0.002, P=0.05 vs controls at 6 months) and triglycerides (from 148.4±35.0 to 122.3±31.4 mg/dl, P=0.001, P=0.01 vs controls at 6 months). Intervention group patients made a total of 1997 phone contacts. The number of phone contacts was correlated positively with Social Functioning (SF), Vitality (VT) and Mental Health (MH) scores of SF-36® at baseline (r=0.48, r=0.41, r=0.41, respectively, P=0.05) but not with weight loss.CONCLUSIONS: Home-centered, intense treatment through the use of telemedicine can be effective in improving short-term obesity outcomes.

Semantic Integration of Cervical Cancer Data Repositories to Facilitate Multicenter Association Studies: The ASSIST Approach

The current work addresses the unification of Electronic Health Records related to cervical cancer into a single medical knowledge source, in the context of the EU-funded ASSIST research project. The project aims to facilitate the research for cervical precancer and cancer through a system that virtually unifies multiple patient record repositories, physically located in different medical centers/hospitals, thus, increasing flexibility by allowing the formation of study groups “on demand” and by recycling patient records in new studies. To this end, ASSIST uses semantic technologies to translate all medical entities (such as patient examination results, history, habits, genetic profile) and represent them in a common form, encoded in the ASSIST Cervical Cancer Ontology. The current paper presents the knowledge elicitation approach followed, towards the definition and representation of the diseases medical concepts and rules that constitute the basis for the ASSIST Cervical Cancer Ontology. The proposed approach constitutes a paradigm for semantic integration of heterogeneous clinical data that may be applicable to other biomedical application domains.

Using contact centers in tele-management and home care of congestive heart failure patients: The CHS experience

The Citizen Health System (CHS) is a European Commission (CEC) funded project in the field of IST for Health. Its main goal is to develop a generic contact center which in its pilot stage can be used in the monitoring, treatment and management of chronically ill patients at home such as congestive heart failure (CHF) patients. Such contact centers, which can use any type of communication and telematics technology, and can provide timely and preventive prompting to the patients are envisaged in the future to evolve into well-being contact centers providing services to all citizens. In this paper, we present the structure of such a generic contact center focusing on the telecommunication infrastructure, the communication protocols and procedures related to the vital parameters and signals, and finally the educational modules that are integrated into this contact center. We present examples of the communication means between the medical professionals using this contact center and the congestive heart failure patients, and elaborate on the telemedicine and educational issues involved.

Preventing obesity and eating disorders through behavioural modifications: The SPLENDID vision

Recent intensive research in the fields of obesity and eating disorders has proved most traditional interventions inadequate: The obesity-targeting interventions have either failed or are strongly social context dependent, while the interventions for eating disorders have poor results and high levels of relapse. On the contrary, recent randomized control trials have illustrated that supervised training of patients to eat and move in a non-pathological way is effective in the prevention of both obesity and eating disorders. Applying the same kind of methodologies to the general population in real life conditions for prevention purposes comes as the logical next step. SPLENDID is a recently initiated EU-funded collaborative project that intends to develop a personalised guidance system for helping and training children and young adults to improve their eating and activity behaviour. By combining expertise in behavioural patterns with current advancements in intelligent systems and sensor technologies, SPLENDID is going to detect subjects at risk for developing obesity or eating disorders and offer them enhanced monitoring and guidance to prevent further disease progression. Both behavioural data collection and system evaluation are going to be performed via pilot studies supported by expert health professionals.

Congestive heart failure management in a home-care system through the CHS contact center

The Citizen Health System (CHS) is a European Commission (CEC) funded project in the field of IST for health. It has developed a generic contact center, which can be used in the monitoring, treatment and management of chronically ill patients at home such as congestive heart failure (CHF) patients. The virtue of the CHS contact center is that using any type of communication and telematics technology it is able to provide timely and preventive prompting to the CHF patients, thus, achieving better disease management. In this paper, we present the quantitative and qualitative results through the use of the CHS contact center by CHF patients, looking at the prevention of complications, the quality of life of the involved patients, and the quality of the medical procedures and interventions used for the CHF disease management. It is shown through specific evidence that the use of the monitoring and interventions through the CHS contact center prevents worsening of the patients condition, something evidenced and supported basically by the sharp reduction in hospitalisation rates for the CHF patients that used the CHS home-care system.

Congenital heart disease patient home care services using the interactive TV: the PANACEIA-ITV approach

In the context of the PANACElA-ITV IST European project, a home care service provision system is described based on interactive TV technology. The purpose of PANACEIA-ITV is to facilitate essential lifestyle changes and to promote compliance with scientifically sound self-care recommendations, through the application of interactive digital television for family health maintenance. The means to achieve these goals are based on technological, health services and business models. PANACEIA-ITV is looking for communication of monitoring micro-devices with ITV set-top-boxes using infrared technology, and embodiment of analogous H/W and S/W in the ITV set-top-boxes. The PANACElA-ITV system is used by patients suffering from adult congenital heart disease (ACHD) at the Royal Brompton Hospital. The primary aim of this pilot is to test whether delivery of high quality monitoring, treatment and education for the ACHD or pulmonary hypertension patient is feasible via interactive television and infrared microdevices. Secondary aims of this pilot are to test the hypothesis that intensified home monitoring and guidance for patients of this target group will lead to reduced ACHD related hospitalization and to evaluate the overall attitude of the patients and clinicians towards the use of new technologies such as ITV in healthcare and disease management.

Diagnostic accuracy of high-risk HPV DNA genotyping for primary cervical cancer screening and triage of HPV-positive women, compared to cytology: preliminary results of the PIPAVIR study

PurposeThe purpose of the presented PIPAVIR (persistent infections with human papillomaviruses; http://www.pipavir.com) subanalysis is to assess the performance of high-risk (hr) HPV-DNA genotyping as a method of primary cervical cancer screening and triage of HPV positive women to colposcopy compared to liquid-based cytology (LBC) in an urban female population.MethodsWomen, aged 30–60, provided cervicovaginal samples at the Family-Planning Centre, Hippokratio Hospital of Thessaloniki, Greece, and the Department of Gynecology and Obstetrics in Mare Klinikum, Kiel, Germany. Cytology and HPV genotyping was performed using LBC and HPV Multiplex Genotyping (MPG), respectively. Women positive for cytology [atypical squamous cells of undetermined significance (ASC-US) or worse] or hrHPV were referred for colposcopy.ResultsAmong 1723/1762 women included in the final analysis, hrHPV and HPV16/18 prevalence was 17.7 and 9.6%, respectively. Cytology was ASCUS or worse in 7.6%. Cervical Intraepithelial Neoplasia grade 2 or worse (CIN2+) was detected in 28 women (1.6%). Sensitivity of cytology (ASCUS or worse) and HPV DNA testing for the detection of CIN2+ was 50.0 and 100%, and specificity was 94.49 and 85.49%, respectively. The screening approach according to which only women positive for HPV16/18 and for hrHPV(non16/18) with ASCUS or worse were referred to colposcopy presented 78.57% sensitivity and 13.17% positive predictive value (PPV).ConclusionsHPV testing represents a more sensitive methodology for primary cervical cancer screening compared to cytology. For triage of HPV positive women to colposcopy, partial HPV genotyping offers better sensitivity than cytology, at the cost of higher number of colposcopies.

SENSATION remote monitoring system for enabling the "anytime, anywhere" monitoring of patients with selected sleep disorders

The SENSATION Integrated Project aims at promoting the health, safety and quality of life of people and protect the environment by reducing relevant accidents and thus the impact on environment through the application of novel micro and nano sensors and related technologies, of low-cost and high-efficiency, for physiological state monitoring. The focus of the work will be the brain activity, including the sleep and wakefulness states and their boundaries, stress, inattention and hypovigilance states, for hypovigilance detection, prediction and management as well as diagnosis, treatment and remote monitoring of sleep disorders. In this paper, a presentation of the application scenarios of the integrated medical system will be made

Human papillomavirus E7 protein detection as a method of triage to colposcopy of HPV positive women, in comparison to genotyping and cytology. Final results of the PIPAVIR study

The objective of the presented cross‐sectional‐evaluation‐screening study is the clinical evaluation of high‐risk(hr)HPVE7‐protein detection as a triage method to colposcopy for hrHPV‐positive women, using a newly developed sandwich‐ELISA‐assay. Between 2013‐2015, 2424 women, 30‐60 years old, were recruited at the Hippokratio Hospital, Thessaloniki/Greece and the Im Mare Klinikum, Kiel/Germany, and provided a cervical sample used for Liquid Based Cytology, HPV DNA genotyping, and E7 detection using five different E7‐assays: “recomWell HPV16/18/45KJhigh”, “recomWell HPV16/18/45KJlow”, “recomWell HPV39/51/56/59”, “recomWell HPV16/31/33/35/52/58” and “recomWell HPVHRscreen” (for 16,18,31,33,35,39,45,51,52,56,58,59 E7), corresponding to different combinations of hrHPVE7‐proteins. Among 1473 women with eligible samples, those positive for cytology (ASCUS+ 7.2%), and/or hrHPV DNA (19.1%) were referred for colposcopy. Cervical Intraepithelial Neoplasia grade 2 or worse (CIN2+) was detected in 27 women (1.8%). For HPV16/18‐positive women with no triage, sensitivity, positive predictive value (PPV) and the number of colposcopies needed to detect one case of CIN2+ were 100.0%, 11.11% and 9.0 respectively. The respective values for E7‐testing as a triage method to colposcopy ranged from 75.0‐100.0%, 16.86‐26.08% and 3.83‐5.93. Sensitivity and PPV for cytology as triage for hrHPV(non16/18)‐positive women were 45.45% and 27.77%; for E7 test the respective values ranged from 72.72‐100.0% and 16.32‐25.0%. Triage of HPV 16/18‐positive women to colposcopy with the E7 test presents better performance than no triage, decreasing the number of colposcopies needed to detect one CIN2+. In addition, triage of hrHPV(non16/18)‐positive women with E7 test presents better sensitivity and slightly worse PPV than cytology, a fact that advocates for a full molecular screening approach.