Robert Modre-Osprian

Design and Evaluation of a Telemonitoring Concept Based on NFC-Enabled Mobile Phones and Sensor Devices

Utilization of information and communication technologies such as mobile phones and wireless sensor networks becomes more and more common in the field of telemonitoring for chronic diseases. Providing elderly people with a mobile-phone-based patient terminal requires a barrier-free design of the overall user interface including the setup of wireless communication links to sensor devices. To easily manage the connection between a mobile phone and wireless sensor devices, a concept based on the combination of Bluetooth and near-field communication technology has been developed. It allows us initiating communication between two devices just by bringing them close together for a few seconds without manually configuring the communication link. This concept has been piloted with a sensor device and evaluated in terms of usability and feasibility. Results indicate that this solution has the potential to simplify the handling of wireless sensor networks for people with limited technical skills.

Mobile health (mHealth) based medication adherence measurement – a pilot trial using electronic blisters in diabetes patients

The aim of the present study was to evaluate a mobile health (mHealth) based remote medication adherence measurement system (mAMS) in elderly patients with increased cardiovascular risk treated for diabetes, high cholesterol and hypertension. Cardiovascular risk was defined as the presence of at least two out of the three risk factors: type 2 diabetes, hypercholesterolaemia and hypertension.

Dynamic simulations on the mitochondrial fatty acid beta-oxidation network.

BackgroundThe oxidation of fatty acids in mitochondria plays an important role in energy metabolism and genetic disorders of this pathway may cause metabolic diseases. Enzyme deficiencies can block the metabolism at defined reactions in the mitochondrion and lead to accumulation of specific substrates causing severe clinical manifestations. Ten of the disorders directly affecting mitochondrial fatty acid oxidation have been well-defined, implicating episodic hypoketotic hypoglycemia provoked by catabolic stress, multiple organ failure, muscle weakness, or hypertrophic cardiomyopathy. Additionally, syndromes of severe maternal illness (HELLP syndrome and AFLP) have been associated with pregnancies carrying a fetus affected by fatty acid oxidation deficiencies. However, little is known about fatty acids kinetics, especially during fasting or exercise when the demand for fatty acid oxidation is increased (catabolic stress).ResultsA computational kinetic network of 64 reactions with 91 compounds and 301 parameters was constructed to study dynamic properties of mitochondrial fatty acid β-oxidation. Various deficiencies of acyl-CoA dehydrogenase were simulated and verified with measured concentrations of indicative metabolites of screened newborns in Middle Europe and South Australia. The simulated accumulation of specific acyl-CoAs according to the investigated enzyme deficiencies are in agreement with experimental data and findings in literature. Investigation of the dynamic properties of the fatty acid β-oxidation reveals that the formation of acetyl-CoA – substrate for energy production – is highly impaired within the first hours of fasting corresponding to the rapid progress to coma within 1–2 hours. LCAD deficiency exhibits the highest accumulation of fatty acids along with marked increase of these substrates during catabolic stress and the lowest production rate of acetyl-CoA. These findings might confirm gestational loss to be the explanation that no human cases of LCAD deficiency have been described.ConclusionIn summary, this work provides a detailed kinetic model of mitochondrial metabolism with specific focus on fatty acid β-oxidation to simulate and predict the dynamic response of that metabolic network in the context of human disease. Our findings offer insight into the disease process (e.g. rapid progress to coma) and might confirm new explanations (no human cases of LCAD deficiency), which can hardly be obtained from experimental data alone.

Evaluation of an Integrated Telemonitoring Surveillance System in Patients with Coronary Heart Disease.

OBJECTIVES Cardiovascular diseases are the most frequent cause of death in industrialized countries. Non-adherence with prescribed medication and recommended lifestyle changes significantly increases the risk of major cardiovascular events. The telemonitoring programme MyCor (Myokardinfarkt und Koronarstent Programm in Tirol) is a multi-modal intervention programme to improve lifestyle and medication management of patients with coronary heart disease (CHD). It includes patient education, self-monitoring with goal-setting and feedback, and regular clinical visits. We evaluated the MyCor telemonitoring programme regarding technical feasibility, user acceptance, patient adherence, change in health status, and change in quality of life. METHODS A 4½-month study was conducted with two telemonitoring phases and one interim phase. The study comprised patient surveys, standardized assessment of quality of life using the MacNew questionnaire at study entry and after 4 and 18 weeks, analysis of adherence to medication and physical activity during the two telemonitoring phases, and analysis of reached goals regarding health conditions during the telemonitoring phases. RESULTS Twenty-five patients (mean age: 63 years) participated in the study. Patients showed a high acceptance of the MyCor telemonitoring programme. Patients reported feelings of self-control, motivation for lifestyle changes, and improved quality of life. Adherence to daily measurements was high with 86% and 77% in the two telemonitoring phases. Adherence to medication was also high with up to 87% and 80%. Pre-defined goals for physical activity were reached in up to 86% and 73% of days, respectively. Quality of life improved from 5.5 at study entry to 6.3 at the end (p< 0.01; MacNew questionnaire). Reductions in blood pressure and heart rate or an improvement in reaching defined goals could not be observed. CONCLUSIONS The MyCor telemonitoring programme Tirol for CHD patients has a high rate of acceptance among included patients. Critical evaluation revealed subjective benefits regarding quality of life and health status as well as high adherence rates to medication and lifestyle changes. Achieving long-term adherence and verifying clinical outcomes, however, remains an open issue. Our findings will promote further studies, addressing different strategies for an optimal mix of patient education, telemonitoring, feedback, and clinical follow-ups.

HerzMobil Tirol network: rationale for and design of a collaborative heart failure disease management program in Austria

SummaryHeart failure (HF) is approaching epidemic proportions worldwide and is the leading cause of hospitalization in the elderly population. High rates of readmission contribute substantially to excessive health care costs and highlight the fragmented nature of care available to HF patients. Disease management programs (DMPs) have been implemented to improve health outcomes, patient satisfaction, and quality of life, and to reduce health care costs. Telemonitoring systems appear to be effective in the vulnerable phase after discharge from hospital to prevent early readmissions. DMPs that emphasize comprehensive patient education and guideline-adjusted therapy have shown great promise to result in beneficial long-term effects. It can be speculated that combining core elements of the aforementioned programs may substantially improve long-term cost-effectiveness of patient management.We introduce a collaborative post-discharge HF disease management program (HerzMobil Tirol network) that incorporates physician-controlled telemonitoring and nurse-led care in a multidisciplinary network approach.ZusammenfassungHerzinsuffizienz ist der häufigste Grund für Krankenhausaufnahmen bei älteren Patienten. Die hohe Anzahl rascher Wiederaufnahmen nach Entlassung sind mit hohen Kosten verbunden und widerspiegeln die bislang unzureichende Versorgung dieser Patienten. Disease-Management-Programme (DMPs) sollen die Schnittstellenproblematik zwischen Krankenhaus und niedergelassenem Bereich sowie Lebensqualität und klinischem Langzeitverlauf verbessern, die Eigenkompetenz von Patienten stärken und langfristig die Kosteneffektivität der Versorgung erhöhen. Mit Hilfe von telemedizinischen Einrichtungen können die häufigen Wiederaufnahmen in der vulnerablen Phase nach Krankenhausentlassung reduziert werden. Eine langfristige Stabilisierung ist allerdings nur mit DMPs möglich, welche eine umfassende Schulung von betroffenen Patienten sowie eine konsequente Therapieoptimierung zum Ziel haben. Es ist wahrscheinlich, dass die Kombination derartiger DMPs mit telemedizinischen Systemen sowohl die Effizienz als auch die Kosten-Effektivität der Patientenversorgung verbessert.Wir berichten über ein integratives Versorgungsprojekt für Patienten nach akuter kardialer Dekompensation, bei dem ein nicht-invasives Telemonitoringsystem in ein umfassendes, sektorenübergreifendes Betreuungsnetzwerk eingebunden ist.

Design and evaluation of a multimodal mHealth based medication management system for patient self administration

The intake of prescribed medication presents a challenge, in particular for elderly people and in cases where a variety of medications have to be taken in accordance to a complex schedule. To support patients with this task, an mHealth-concept was developed and evaluated in the course of a clinical trial. The system used a multimodal user interface concept, i.e. both RFID tags and barcodes to identify and document the intake of medications. Results of the clinical study with 20 patients indicate that the multimodal mHealth concept utilizing barcode and RFID tags enabled easy-to-use medication management. Although further clinical evaluation is needed to assess whether such a tool can also enhance adherence, the system shows the potential for targeting the problem of medication management with mHealth methods.

Atrial myocardium model extraction

We present two approaches for reconstructing a patient’s atrial myocardium from morphological image data. Both approaches are based on a segmentation of the left and right atrial blood masses which mark the inner border of the atrial myocardium. The outer border of the atrial myocardium is reconstructed differently by the two approaches. The surface manipulation approach is based on a triangle manipulation procedure while the label-voxel-field approach adds or deletes label-voxels of the segmented blood mass labelset. Both approaches yield models of a patient’s atrial myocardium that qualify for further applications. The obtained atrial models have been implemented many times in the construction of a patient’s volume conductor model needed for solving the electrocardiographic inverse problem. The label-voxel-field approach has to be favored because of its superior performance and ability of implementation in a segmentation pipeline.

Targeted Metabolomics for Clinical Biomarker Discovery in Multifactorial Diseases

The vast majority of this book deals with monogenic disorders which are relatively rare but have just one or a small number of characteristic genotypes and usually very pronounced clinical and biochemical phenotypes. In contrast, this chapter will try to discuss multifactorial diseases which are far more prevalent and pose a completely different kind of challenge both for the socio-economic systems and for biomedical research. As an example we will focus on chronic kidney disease (CKD) and relevant animal models thereof. In fact, together with diabetic retinopathy, myocardial infarction, and stroke, diabetic nephropathy is one of the most severe sequelae of type II diabetes mellitus (T2D) and, considering the obesity-related pandemic of T2D, will represent a major health issue in the decades to come (Mensah et al., 2004; James et al., 2010). Of course, all of these diseases have an important genetic component as demonstrated by pedigree analyses and a growing number of twin studies (Walder et al., 2003; Vaag & Poulsen, 2007). Still, with rare exceptions, this genetic component is rather seen as a predisposition for than as a cause of the actual disease. In particular, recent genome-wide association studies (GWAS) on large population-based cohorts have revealed a couple of single nucleotide polymorphisms (SNPs) that are significantly associated with T2D but the contribution of single SNPs to the individual’s risk of developing T2D are marginal (Groop & Lyssenko, 2009). To fully understand the interaction of the identified genetic loci and to appreciate the meaning of the genetic background in a personalized medicine approach, complex haplotypes would have to be analyzed, and this has not even been achieved in basic diabetes research, let alone in any clinical application. Yet, genetic research in diabetology has gained a new momentum in the last few years since it became obvious that a combination of GWAS with a more detailed phenotyping than just a generic diagnosis of T2D immediately led to improved statistics and to a much better biochemical plausibility of the findings (Gieger et al., 2008; Illig et al., 2010). Specifically, genome-wide significances could be achieved on much smaller cohorts than in classical GWAS rendering a more cost-efficient tool in biomedical research. The statistical power could be further improved by defining metabolic phenotypes based on the knowledge of the underlying biochemical pathways, e.g., by using groups of metabolites that are synthesized or degraded by the same enzymes or by calculating ratios of the concentrations of products

An Epidemiological Modeling and Data Integration Framework

OBJECTIVES In this work, a cellular automaton software package for simulating different infectious diseases, storing the simulation results in a data warehouse system and analyzing the obtained results to generate prediction models as well as contingency plans, is proposed. The Brisbane H3N2 flu virus, which has been spreading during the winter season 2009, was used for simulation in the federal state of Tyrol, Austria. METHODS The simulation-modeling framework consists of an underlying cellular automaton. The cellular automaton model is parameterized by known disease parameters and geographical as well as demographical conditions are included for simulating the spreading. The data generated by simulation are stored in the back room of the data warehouse using the Talend Open Studio software package, and subsequent statistical and data mining tasks are performed using the tool, termed Knowledge Discovery in Database Designer (KD3). RESULTS The obtained simulation results were used for generating prediction models for all nine federal states of Austria. CONCLUSION The proposed framework provides a powerful and easy to handle interface for parameterizing and simulating different infectious diseases in order to generate prediction models and improve contingency plans for future events.

Cardiac modeling using active appearance models and morphological operators

We present an approach for fast reconstructing of cardiac myocardium and blood masses of a patients heart from morphological image data, acquired either MRI or CT, in order to estimate numerically the spread of electrical excitation in the patients atria and ventricles. The approach can be divided into two main steps. During the first step the ventricular and atrial blood masses are extracted employing Active Appearance Models (AAM). The left and right ventricular blood masses are segmented automatically after providing the positions of the apex cordis and the base of the heart. Because of the complex geometry of the atria the segmentation process of the atrial blood masses requires more information as the ventricular blood mass segmentation process of the ventricles. We divided, for this reason, the left and right atrium into three divisions of appearance. This proved sufficient for the 2D AAM model to extract the target blood masses. The base of the heart, the left upper and left lower pulmonary vein from its first up to its last appearance in the image stack, and the right upper and lower pulmonary vein have to be marked. After separating the volume data into these divisions the 2D AAM search procedure extracts the blood masses which are the main input for the second and last step in the myocardium extraction pipeline. This step uses morphologically-based operations in order to extract the ventricular and atrial myocardium either directly by detecting the myocardium in the volume block or by reconstructing the myocardium using mean model information, in case the algorithm fails to detect the myocardium.