A mbulatory Telemonitoring of Physiologic Data: A Systematic Review

1. Ambulatory Telemonitoring of Physiologic Data: A Systematic Review Introdução à Medicina 08/09 Class n.5 1

2. In this new century medicine is facing a new challenge called TELEMONITORING Telemonitoring allows the use of electronic equipment to observe or record physiologic processes while the patient undergoes normal daily activities. AMBULATORY TELEMONITORING [Mehmet R. Yuce, Peng Choong Ng, Jamil Y. Khan, Monitoring of Physiological Parameters from Multiple Patients Using Wireless Sensor Network, April 2008, Springer Science + Business Media, LLC 2008 ] 2

3. Ambulatory Telemonitoring allows: • To collect part of the diagnostic's relevant information • To gather more information with less effort • To follow the patients closely spending less time. [Otto, C. A., Jovanov, E., and Milenkovic, E., A WBAN-based system for health monitoring at home. In 3rd IEEE/EMBS Int. Summer School, Medical Devices and Biosensors. Sept, 20–23, 2006.] [N. Oliver and F. F. Mangas, “HealthGear: a real-time wearable system for monitoring and analyzing physiological signals,” Tech. Rep. MSR-TR-2005-182, Microsoft Corporation, Red-mond, Wass, USA, 2005 ] 3

4. A simple and not very restricted search at Pubmed QUERY: (telemonitoring[All Fields] OR "telemedicine"[MeSH Terms] OR "telemedicine"[All Fields]) AND ambulatory[All Fields] 4

5. Publications indexed by Pubmed from 1990 - 500 articles about ambulatory telemonitoring - more than 93% of the publication's dates are from 2000 to the present year. This revels not only how recent this matter is, but also its emerging relevance. 5

6. …However, the domains in which ambulatory telemonitoring is being used are not very clear! On which healthcare domains has ambulatory telemonitoring of physiologic data been used? 6

7. THE MAIN OBJECTIVE •Find out on which healthcare domains ambulatory telemonitoring of physiologic data has been used. 7

8. SPECIFICOBJECTIVES - Expose the scientific evidence, produced by experimental studies, supporting the use of ambulatory telemonitoring in different fields of healthcare. - Determine which healthcare domains have been targeted by ambulatory telemonitoring of physiologic data. - Analyze which types of physiological data have been monitored and transmitted in ambulatory telemonitoring. - Identify on which healthcare effects does scientific evidence exist on the advantages or disadvantages of ambulatory telemonitoring of physiologic data (health improvement, system usability, patient acceptance, etc.). 8

9. METHODS: Systematic Review A) Analysis unit: studies and research works B) Formulation of a clear, focused question C) Study Variables 9

10. Study Variables: • Medical areas where this equipment is used • The type of physiological data monitorized • Articles’s year of publication in order to analyze how recent the subject is • Patient population (intervention and exposure) • Comparison intervention (outcome versus indoor) • Economic points 10

11. METHODS: Systematic Review D) A comprehensive literature search was conducted on Pubmed and ISI to identify relevant published articles. 11

12. METHODS: Systematic Review Keywords: physiological, physiologic, process, phenoma, monitor, ambulatory, outpatients, non- hospital, telemedicine, telemonitoring, self monitoring, supervise,telesurveillance. 12

13. DEFINITION Ambulatory: medical care including diagnosis, observation, treatment and rehabilitation that is provided on an outpatients basis. Ambulatory care is given to persons who are able to ambulate or walk about. [www.medterms.com.script/main/art.asp?articlekey=2218] 13

14. DEFINITION Telemonitoring:includes the collection of clinical data and the transmission of such data between a patient at a distant location and a health care provider through electronic information processing technologies. (Home Telehealth Reference 2005) (http://www.homehealthquality.org/shared/content/hhqi_campain/bpip_tm/Therapy.pdf)‏ 14

15. DEFINITION Physiological phenomena: observable or measurable characteristics of the ocular system, the respiratory system, the musculoskeletal system, the nervous system or of the blood. (http://www.ncbi.nlm.nih.gov.sites/entrez)‏ 15

16. Methods 16

17. Query “telemonitoring/telemedicine” • ("telemedicine"[MeSH Terms] OR "telemedicine"[All Fields] OR telemonitoring[All Fields] OR telemonitor[All Fields] OR "self monitor"[All Fields] OR "self monitoring"[All Fields] OR "supervise"[All Fields] OR "telesurveillance"[All Fields]). PUBMED: NUMBER OF ARTICLES: 15838 17

18. Query “physiological data” • ("physiological"[All Fields] OR "physiologic"[All Fields] OR physiologically[All Fields] OR process[All Fields] OR phenoma[All Fields] OR phenomal[All Fields]). PUBMED: NUMBER OF ARTICLES: 915566 18

19. Query “ambulatory/telemonitoring” • (monitor [All Fields] OR ambulatory OR "outpatients"[MeSH Terms] OR "outpatients"[All Fields] OR "outpatient"[All Fields] OR non-hospital[All Fields] OR "monitoring, ambulatory"[MeSH Terms]). PUBMED: NUMBER OF ARTICLES: 224872 19

20. ("physiological"[All Fields] OR "physiologic"[All Fields] OR physiologically[All Fields] OR process[All Fields] OR phenoma[All Fields] OR phenomal[All Fields]) AND (monitor [All Fields] OR ambulatory OR "outpatients"[MeSH Terms] OR "outpatients"[All Fields] OR "outpatient"[All Fields] OR non-hospital[All Fields] OR "monitoring, ambulatory"[MeSH Terms]) AND ("telemedicine"[MeSH Terms] OR "telemedicine"[All Fields] OR telemonitoring[All Fields] OR telemonitor[All Fields] OR "self monitor"[All Fields] OR "self monitoring"[All Fields] OR "supervise"[All Fields] OR "telesurveillance"[AllFields]). PUBMED: NUMBER OF ARTICLES: 287 20

21. Methods 1st. REVISION: • Revision by title and • abstract • Define exclusion/inclusion criteria‏ • - Number of reviewers: 2 21

22. Inclusion/Exclusion criteria 22

23. Methods 2nd. REVISION: • Revision by full article • ‏ • - Number of reviewers: 2 23

24. Methods After the data extraction: - To check for and identify sources of heterogeneity in results across studies - Determine sources of heterogeneity Findings/Results of individual studies Synthesised and subsequently analysed. The results and recommendations are reported. Statistical Study 24

25. Statistical Study According to the defined study variables 25

26. Expected Results • The healthcare domains where ambulatory telemonitoring is applied nowadays and the magnitude of its use versus the areas where this type of monitoring is not viable. • The types of physiologic data collected by the different kinds of sensors. • The advantages or disadvantages to patients and healthcare providers when telemonitoring is used. • The economic viability of this procedure. 26

27. All the references: [1] Louis AA, Turner T, Gretton M, Baksh A, Cleland JG., A systematic review of telemonitoring for the management of heart failure, Eur J Heart Fail. 2003 Oct;5(5):583-90, Review. [2] Mehmet R. Yuce, Peng Choong Ng, Jamil Y. Khan, Monitoring of Physiological Parameters from Multiple Patients Using Wireless Sensor Network, April 2008, Springer Science + Business Media, LLC 2008 [3] Otto, C. A., Jovanov, E., and Milenkovic, E., A WBAN-based system for health monitoring at home. In 3rd IEEE/EMBS Int. Summer School, Medical Devices and Biosensors. Sept, 20–23, 2006. [4] GUY PARÉ, et al, Systematic Review of Home Telemonitoring for Chronic Diseases: The Evidence Base, Journal of the American Medical Informatics Association Volume 14 Number 3 May / June 2007. [5] N. Oliver and F. F. Mangas, “HealthGear: a real-time wearable system for monitoring and analyzing physiological signals,” Tech. Rep. MSR-TR-2005-182, Microsoft Corporation, Red-mond, Wass, USA, 2005 [6] P.T. Cheng, L.M. Tsai, L.W. Lu, and D.L. Yang. The design of pda-based biomedical data processing and analysis for intelligent wearable health monitoring systems. In Proc. Intl. Conf. Computer and Information Technology (CIT’04). [7] D. Konstantas, A.V. Halteren, R. Bults, K. Wac, I. Widya, N. Dokovsky, G. Koprinkov, V. Jones, and R. Herzog. Mobile patient monitoring: the mobihealth system. In Proc. Int. Conf. on Medical and Care Compunetics, NCC’04, 2004. [8] D. Malan, T. Fulford-Jones, M. Welsh, and S. Moulton. Codeblue: An ad-hoc sensor network infrastructure for emergency medical care. In Proc. Int. Workshop on Wearable and Implantable Body Sensor Networks, 2004. 27

28. [9] K.M. Scannell, D.A. Perednia, and H.M. Kissman. Telemedicine: Past, present, future. Technical report, U.S. Department of Health and Human Services. National Library of Medicine. Reference Section., 1995. [10] R. Fensli, et al, Sensor Acceptance Model– Measuring Patient Acceptance of Wearable Sensors, Schattauer GmbH, 2008. [11] Y. Hao and R. Foster, Wireless Body Sensor Network for Health-MonitoringApplications, Department of Electronic Engeneering, Queen Mary, University of London, 2008[12] Paré Guy, Jaana Mirou, Sicotte Claude, Systematic Review of Home Telemonitoring for Chronic Diseases: The Evidence Base, Journal of The American Medical Information Association, Volume 14, Number 3, May / June 2007 28

29. Authors: ALVES, José Pedro Figueiral Oliva Soares; CAMPOS, Marta Sofia Gomes; DATA, Tânia Rodrigues; ESTEVES, Alexandra Sofia Moreira; FARIA, Carlos Augusto da Silva; FERNANDES, Diana da Silva; GUEDES, Paulo Renato Moreira; MACHADO, Marino João Pinto; MAGALHÃES, Ana Isabel Pereira; MARQUES, Pedro Seabra; MATOS, José Pedro Rodrigues; MELO, Inês Marisa Tribuzi de Magalhães; MOREIRA, Pedro Manuel Costa; NASCIMENTO, João António Santos; PEREIRA, Maria Francisca Azevedo Marques; SILVA, Ana Rita Carneiro. Authors’ e-mail: intromed05@gmail.com Adviser: RODRIGUES, Pedro Pereira. Class Number: 05  29