Unconstrained physiological monotoring in daily living for health care

Measurement of electrocardiograms in a bath through tap water utilizing capacitive coupling electrodes placed outside the bathtub wall

BACKGROUND

Taking a bath sometimes poses a risk for subjects with chronic cardiopulmonary disorders, due to the thermal effect and water pressure on his/her body. The ECG measurement would be helpful for the early recognition of abnormal cardiac beats and respiratory conditions. This paper describes a new attempt to improve on previous bathtub ECG measurement techniques that had electrodes placed inside the bathtub that were intrusive to the subjects' bathing experience. This study is concerned with the initial development of a method to measure an electrocardiogram (ECG) through tap water without conscious awareness of the presence of electrodes that are placed outside the bathtub wall.

METHODS

A configuration of capacitive coupling electrodes placed outside the bathtub was designed so that the electrodes could be hidden. The capacitive coupling was made from the electrodes to the water through the bathtub wall. Two electrodes with an active shielding amplifier covered further by an electromagnetic shield were fixed to the outside surface of the bathtub wall, near the bather's right scapula and left foot. The potential difference between these two electrodes, similar to the bipolar lead-II ECG, was amplified to obtain raw signals inclusive of ECG/QRS components. Respiration intervals were also derived from ECG/RR intervals. Comparison experiments between this bathtub method and conventional direct methods with spot-electrodes and a chest-band sensor were made using 10 healthy male volunteers (22.2 ± 0.98 years).

RESULTS

The ECG signal was detectable through tap water as well as water with differing conductivity resulting from mixing bathwater additives with the water. ECG signals and respiration curves derived from ECG/RR intervals were successfully obtained in all subjects. The intervals of the ECG/RR and respiration obtained by the bathtub system and by the direct method were respectively agreed well with each other.

CONCLUSION

The ECG signal, in particular ECG/QRS components, were successfully detected utilizing capacitive coupling electrodes placed outside the bathtub wall. Also, the ECG/RR and respiration intervals were determined with reasonable accuracy as compared with the conventional direct methods.

Smart health monitoring systems: an overview of design and modeling

Health monitoring systems have rapidly evolved during the past two decades and have the potential to change the way health care is currently delivered. Although smart health monitoring systems automate patient monitoring tasks and, thereby improve the patient workflow management, their efficiency in clinical settings is still debatable. This paper presents a review of smart health monitoring systems and an overview of their design and modeling. Furthermore, a critical analysis of the efficiency, clinical acceptability, strategies and recommendations on improving current health monitoring systems will be presented. The main aim is to review current state of the art monitoring systems and to perform extensive and an in-depth analysis of the findings in the area of smart health monitoring systems. In order to achieve this, over fifty different monitoring systems have been selected, categorized, classified and compared. Finally, major advances in the system design level have been discussed, current issues facing health care providers, as well as the potential challenges to health monitoring field will be identified and compared to other similar systems.

Fully automatic system for monitoring blood pressure from a toilet-seat using the volume-oscillometric method

Daily monitoring of health condition at home is very important subject not only as an effective scheme for early diagnosis and treatment of cardiovascular and other diseases, but also for prevention and control of such diseases. From this point of view, we have been developing a fully automated "non-conscious" monitoring system for home health care. In this paper are described, structural detail of a newly developed toilet-seat-installed blood pressure measurement system and some results obtained by the system. Also described is outline of a newly designed system for measuring hydrostatic pressure difference between the heart and the measuring site, i.e., thigh, during blood pressure measurement.

Development of a ubiquitous healthcare monitoring system combined with non-conscious and ambulatory physiological measurements and its application to medical care

The demand for ubiquitous healthcare monitoring has been increasingly raised for prevention of lifestyle-related diseases, acute life support or chronic therapies for inpatients and/or outpatients having chronic disorder and home medical care. From these view points, we developed a non-conscious healthcare monitoring system without any attachment of biological sensors and operations of devices, and an ambulatory postural changes and activities monitoring system. Furthermore in this study, in order to investigate those applicability to the ubiquitous healthcare monitoring, we have developed a new healthcare monitoring system combined with the non-conscious and the ambulatory measurements developed by us. In patients with chronic cardiovascular disease or stroke, the daily health conditions such as pulse, respiration, activities and so on, could be continuously measured in the hospital, the rehabilitation room and subject's own home, using the present system. The results demonstrated that the system appears useful for the ubiquitous healthcare monitoring not only at medical facility, but also during daily living at home.

A fully automated health-care monitoring at home without attachment of any biological sensors and its clinical evaluation

Daily monitoring of health condition is important for an effective scheme for early diagnosis, treatment and prevention of lifestyle-related diseases such as adiposis, diabetes, cardiovascular diseases and other diseases. Commercially available devices for health care monitoring at home are cumbersome in terms of self-attachment of biological sensors and self-operation of the devices. From this viewpoint, we have been developing a non-conscious physiological monitor installed in a bath, a lavatory, and a bed for home health care and evaluated its measurement accuracy by simultaneous recordings of a biological sensors directly attached to the body surface. In order to investigate its applicability to health condition monitoring, we have further developed a new monitoring system which can automatically monitor and store the health condition data. In this study, by evaluation on 3 patients with cardiac infarct or sleep apnea syndrome, patients' health condition such as body and excretion weight in the toilet and apnea and hypopnea during sleeping were successfully monitored, indicating that the system appears useful for monitoring the health condition during daily living.

Can we improve the clinical utility of respiratory rate as a monitored vital sign?

Respiratory rate (RR) is a basic vital sign, measured and monitored throughout a wide spectrum of health care settings, although RR is historically difficult to measure in a reliable fashion. We explore an automated method that computes RR only during intervals of clean, regular, and consistent respiration and investigate its diagnostic use in a retrospective analysis of prehospital trauma casualties. At least 5 s of basic vital signs, including heart rate, RR, and systolic, diastolic, and mean arterial blood pressures, were continuously collected from 326 spontaneously breathing trauma casualties during helicopter transport to a level I trauma center. "Reliable" RR data were identified retrospectively using automated algorithms. The diagnostic performances of reliable versus standard RR were evaluated by calculation of the receiver operating characteristic curves using the maximum-likelihood method and comparison of the summary areas under the receiver operating characteristic curves (AUCs). Respiratory rate shows significant data-reliability differences. For identifying prehospital casualties who subsequently receive a respiratory intervention (hospital intubation or tube thoracotomy), standard RR yields an AUC of 0.59 (95% confidence interval, 0.48-0.69), whereas reliable RR yields an AUC of 0.67 (0.57-0.77), P < 0.05. For identifying casualties subsequently diagnosed with a major hemorrhagic injury and requiring blood transfusion, standard RR yields an AUC of 0.60 (0.49-0.70), whereas reliable RR yields 0.77 (0.67-0.85), P < 0.001. Reliable RR, as determined by an automated algorithm, is a useful parameter for the diagnosis of respiratory pathology and major hemorrhage in a trauma population. It may be a useful input to a wide variety of clinical scores and automated decision-support algorithms.

Robust ballistocardiogram acquisition for home monitoring

The ballistocardiogram (BCG) measures the reaction of the body to cardiac ejection forces, and is an effective, non-invasive means of evaluating cardiovascular function. A simple, robust method is presented for acquiring high-quality, repeatable BCG signals from a modified, commercially available scale. The measured BCG waveforms for all subjects qualitatively matched values in the existing literature and physiologic expectations in terms of timing and IJ amplitude. Additionally, the BCG IJ amplitude was shown to be correlated with diastolic filling time for a subject with premature atrial contractions, demonstrating the sensitivity of the apparatus to beat-by-beat hemodynamic changes. The signal-to-noise ratio (SNR) of the BCG was estimated using two methods, and the average SNR over all subjects was greater than 12 for both estimates. The BCG measurement was shown to be repeatable over 50 recordings taken from the same subject over a three week period. This approach could allow patients at home to monitor trends in cardiovascular health.

Development of a fully automated network system for long-term health-care monitoring at home

Daily monitoring of health condition at home is very important not only as an effective scheme for early diagnosis and treatment of cardiovascular and other diseases, but also for prevention and control of such diseases. From this point of view, we have developed a prototype room for fully automated monitoring of various vital signs. From the results of preliminary experiments using this room, it was confirmed that (1) ECG and respiration during bathing, (2) excretion weight and blood pressure, and (3) respiration and cardiac beat during sleep could be monitored with reasonable accuracy by the sensor system installed in bathtub, toilet and bed, respectively.

Heart rate measurement based on a time-lapse image

Using a time-lapse image acquired from a CCD camera, we developed a non-contact and non-invasive device, which could measure both the respiratory and pulse rate simultaneously. The time-lapse image of a part of the subject's skin was consecutively captured, and the changes in the average image brightness of the region of interest (ROI) were measured for 30s. The brightness data were processed by a series of operations of interpolation as follows a first-order derivative, a low pass filter of 2 Hz, and a sixth-order auto-regressive (AR) spectral analysis. Fourteen sound and healthy female subjects (22-27 years of age) participated in the experiments. Each subject was told to keep a relaxed seating posture with no physical restriction. At the same time, heart rate was measured by a pulse oximeter and respiratory rate was measured by a thermistor placed at the external naris. Using AR spectral analysis, two clear peaks could be detected at approximately 0.3 and 1.2 Hz. The peaks were thought to correspond to the respiratory rate and the heart rate. Correlation coefficients of 0.90 and 0.93 were obtained for the measurement of heart rate and respiratory rate, respectively.

Personal recognition using head-top image for health-monitoring system in the home

Automatic health-monitoring systems for the smart house are being developed for the elderly. An automatic health-monitoring system needs a way of personal recognition when two or more aged persons live together. We propose a personal recognition method based on the space spectrum of the head-top image. We examined 33 head-top images from eleven subjects and achieved a personal recognition rate of 86.4 percent. When one subject with thinning hair was excluded, the personal recognition rate was 90.0 percent in 30 head-top images from ten subjects.

Potential impact of advanced clinical information technology on cancer care in 2015

New clinical information technologies now sporadically available will soon be in routine clinical use, bringing many changes to all phases of the cancer care continuum. For example, new technologies such as: (1) The next generation Internet; (2) Real-time clinical decision support systems; (3) Off-line, population-based systems; (4) Large, integrated, individual patient-level phenotypic and genotypic databases with intelligent data mining capabilities; (5) Wireless, invasive and non-invasive physiologic monitoring devices; (6) Natural Language Processing (NLP) systems; and (7) Mathematical models of complex biological systems all have the potential to impact significantly the provision of cancer care throughout its continuum. While new information management and communication techniques and technologies will reduce many of the inefficiencies and inaccuracies of our present systems, there will be an equal, and potentially far more dangerous, set of unintended consequences. Informatics investigators, cancer specialists, and health system administrators must focus on the study of what is working and what is not, as well as, on development and testing of the new clinical information management and communication technologies, if we are to be ready for the future.

Continuous non-invasive blood pressure monitoring using concentrically interlocking control loops

A new method and apparatus for non-disruptive blood pressure (BP) recording in the finger based on the vascular unloading technique is introduced. The instrument, in contrast to intermittent set point readjustments of the conventional vascular unloading technique, delivers BP without interruptions, thus refining the Penáz' principle. The method is based on concentrically interlocking control loops for correct long-term tracing of finger BP, including automatic set point adaptation, light control and separate inlet and outlet valves for electro-pneumatic control. Examples of long-term BP recordings at rest and during autonomic function tests illustrate the potential of the new instrument.

Non-invasive Monitoring of Hemodynamic Changes During Hemodialysis by the Use of a Newly Developed Admittance Cardiograph

Only a little information is available for the evaluation of the complex hemodynamic changes that occur during hemodialysis. Recently, we developed the transthoracic electrical admittance cardiograph for repeated measurements of cardiac output, and monitored hemodynamic changes during hemodialysis by the use of this device. We measured cardiovascular hemodynamic and autonomic parameters non-invasively during 210 min of hemodialysis in 19 chronic hemodialysis patients who for more than 2 months had no history of cardiovascular collapses during hemodialysis. Blood pressure was monitored every 10 min using a cuff-oscillometric device (TM-2425; A & D, Tokyo, Japan). Cardiac output was monitored on a beat-by-beat basis by a newly developed electrical admittance cardiograph (NICOVIEW PA1100; NEC, Tokyo, Japan). Electrocardiogram R-R intervals were also monitored by the TM-2425. Power spectral analysis of R-R intervals was performed to obtain the low-frequency (LF; 0.05-0.15 Hz) and the high-frequency (HF; 0.15-0.40 Hz) components based on an autoregressive model. Change in circulatory blood volume was also monitored by a CRIT-LINE (In-Line Diagnostics, Riverdale, UT, USA). Although blood volume declined significantly by 16.3 +/- 1.4% (mean +/- SE) during hemodialysis (P < 0.0001), mean blood pressure did not change significantly. Heart rate increased significantly from the initial values of 76.3 +/- 3.4-86.4 +/- 4.9 beats/min (P = 0.03). Cardiac output and stroke volume decreased significantly from 4.47 +/- 0.30 to 2.91 +/- 0.32 L/min (P < 0.0001), and from 57.0 +/- 3.7 to 33.9 +/- 3.1 mL (P < 0.0001), respectively. Total peripheral vascular resistance increased significantly from 1940 +/- 146 to 3117 +/- 280 dyne x s x cm(5) (P < 0.0001). The LF component did not show significant change, while the HF component decreased significantly (P = 0.007), and the LF/HF ratio increased significantly (P = 0.03). These results suggest that a reduction in parasympathetic nerve activity and sympathetic nerve activation and a marked increase in total peripheral vascular resistance are responsible for the maintenance of blood pressure during hemodialysis in chronic hemodialysis patients. The admittance cardiograph seems to be one of the best options for serial measurements of cardiac output.