Thèses sur le sujet « Personalised healthcare »

A growing number of factors, including the costs, technological advancements, an ageing population, and medical errors are leading industrialised countries to invest in research on alternative solutions to improving their health care systems and increasing patients’ life quality. Personal Health System (PHS) solutions envision the use of information and communication technologies that enable a paradigm shift from the traditional hospital-centred healthcare delivery model toward a preventive and person-centred approach. PHS offers the means to follow patient health using wearable, portable or implantable systems that offer ubiquitous, unobtrusive bio-data acquisition, allowing remote access to patient status and treatment monitoring. Electrical Bioimpedance (EBI) technology is a non-invasive, quick and relatively affordable technique that can be used for assessing and monitoring different health conditions, e.g., body composition assessments for nutrition. EBI technology combined with state-of-the-art advances in sensor and textile technology are fostering the implementation of wearable bioimpedance monitors that use functional garments for the implementation of personalised healthcare applications. This research studies the development of a portable EBI spectrometer that can use dry textile electrodes for the assessment of body composition for the purposes of clinical uses. The portable bioimpedance monitor has been developed using the latest advances in system-on-chip technology for bioimpedance spectroscopy instrumentation. The obtained portable spectrometer has been validated against commercial spectrometer that performs total body composition assessment using functional textrode garments. The development of a portable Bioimpedance spectrometer using functional garments and dry textile electrodes for body composition assessment has been shown to be a feasible option. The availability of such measurement systems bring closer the real implementation of personalised healthcare systems.

QC 20130405

Human red blood cell production, or erythropoiesis, occurs within bone marrow. Living animal and human cadaver models have demonstrated the marrow production of red blood cells is a spatially-complex process, where cells replicate, mature, and migrate between distinct niches defined by biochemical nutrient access, supportive neighboring cells, and environmental structure. Unfortunately, current research in understanding normal and abnormal human production of blood takes place in petri dishes and t-flasks as 2D liquid suspension cultures, neglecting the role of the marrow environment for blood production. The culture of blood on marrow-mimetic 3D biomaterials has been used as a laboratory model of physiological blood production, but lacks characterization. In this work, a 3D biomaterial platform is developed and to capture the in vivo blood production process and manufacture red blood cells from human umbilical cord blood. First ceramic hollow fibres were designed and tested to be incorporated and perfused in a 3D porous scaffold bioreactor to mimic marrow structure, provide a better expansion of cell numbers, a better diffusion of nutrients, and allow for the continuous, non-invasive harvest of small cells in comparison to static, unperfused biomaterials. Quantitative 3D image analysis tools were developed to spatially assess bioreactor distributions and associations of and between different cell types. Using these tools, the bioreactor distribution of red blood cell production were characterized within niches in collaboration with supportive, non-blood cell types and designed miniaturised, parallelised mini-bioreactors to further explore bioreactor capabilities. This thesis presents a hollow fibre bioreactor able to produce blood cells alongside supportive cells at 1,000-fold higher cell densities with 10-fold fewer supplemented factor than flask cultures, without serum, with one cell source, and continuously harvest enucleate red blood cell product to provide a physiologically-relevant model for cell expansion protocols.

Wards occupy significant proportions of hospital floor areas and due to their constant use, represent a worthwhile focus of study. Single-bed wards are specifically of interest owing to the isolation aspect they bring to infection control, including airborne pathogens, but threats posed by airborne pandemics and family-involvement in hospital care means cross-infection is still a potential problem. In its natural mode, ventilation driven by combined wind and buoyancy forces can lead to energy savings and achieve thermal comfort and high air change rates through secure openings. These are advantageous for controlling indoor airborne pathogens and external air and noise pollution. However, there is lack of detailed evidence and guidance is needed to gain optimum performance from available natural ventilation systems. This research is a proof of concept investigation into the feasibility and impact of natural ventilation systems targeting airflow rates, thermal comfort, heating energy and control of pathogenic bio-aerosols in hospital wards. In particular, it provides insights into the optimal areas of vent openings which could satisfy the complex three-pronged criteria of contaminant dilution, low heating energy and acceptable thermal comfort for occupants in a naturally ventilated single bed ward. The main aim of this thesis is the structured study of four systems categorised into three groups: Simple Natural Ventilation (SNV) in which single and dual-openings are used on the same external wall; Advanced Natural Ventilation (ANV) which is an emerging concept; and finally Natural Personalised Ventilation (NPV) which is an entirely new concept borne out of the limitations of previous systems and gaps in literature. The focus of this research is in the exploratory study of the weaknesses and potentials of the four systems, based on multi-criteria performances metrics within three architecturally distinct single-bed ward designs. In contributing to the body of existing knowledge, this thesis provides a better understanding of the performances of three existing systems while presenting the new NPV system. The analysis is based on dynamic thermal modelling and computational fluid dynamics and in the case of the NPV system, salt-bath experiments for validation and visualisation of transient flows. In all cases, wards were assumed to be free of mechanical ventilation systems that might influence the natural flow of air. The thesis meets three major objectives which have resulted in the following contributions to current knowledge: An understanding of the limitations and potentials of same-side openings, especially why and how dual-openings can be useful when retrofitted into existing wards. Detailed analysis of bulk airflow, thermal comfort, heating energy and room air distribution achievable from existing SNV and ANV systems, including insights to acceptable trickle ventilation rates, which will be particular useful in meeting minimum dilution and energy requirements in winter. This also includes qualitative predictions of the airflow pattern and direction obtainable from both systems. The innovation and study of a new natural ventilation system called Natural Personalised Ventilation (NPV) which provides fresh air directly over a patient s bed, creating a mixing regime in the space and evaluation of its comfort and energy performances. A low-energy solution for airborne infection control in clinical spaces is demonstrated by achieving buoyancy-driven mixing ventilation via the NPV system, and a derivative called ceiling-based natural ventilation (CBNV) is shown. A comparative analysis of four unique natural ventilation strategies including their performance rankings for airflow rates, thermal comfort, energy consumption and contaminant dilution or removal using an existing single-bed ward design as case study. Development of design and operational recommendations for future guidelines on utilising natural ventilation in single-bed wards either for refurbishment or for proposed designs. These contributions can be extended to other clinical and non-clinical spaces which are suitable to be naturally ventilated including treatment rooms, office spaces and waiting areas. The findings signify that natural ventilation is not only feasible for ward spaces but that there is opportunity for innovation in its application through further research. Future work could focus on related aspects like: impacts of fan-assisted ventilation for a hybrid flow regime; pre-heating of supply air; integration with passive heat recovery systems as well the use of full-scale experiments to fine-tune and validate findings.

Recent decades have seen increasing recognition of the importance of patient involvement during patient-professional interactions and promotion of preventative and long term approaches to healthcare for those with long-term conditions. The concepts of 'shared decision making' and 'personalised care planning' have both been advocated by patient groups, policy-makers, professional bodies and academia as best practice. During shared decision making, patients and healthcare professionals work in equal partnership to decide the best course of action. Shared decision making is a central tenet of personalised care planning, as it aims to foster partnerships between patients and healthcare professionals when making decisions, but personalised care planning also describes an overall approach to healthcare that is forward-planning and preventative, rather than episodic and reactive. Despite the breadth of support for such approaches, in reality they are not routinely adopted. Multiple Sclerosis (MS) is a heterogeneous neurodegenerative long term condition, which is unpredictable with limited treatments available. Such uncertainty and complexity position MS as an interesting long term condition to explore decisional and information needs. This doctoral research comprises of three methods stages. Firstly, two systematic reviews assessing the effectiveness of personalised care planning for people with long-term conditions and people with MS were carried out. Secondly, 22 in-depth semi-structured qualitative interviews were carried out with people with MS across the UK to explore experiences of decision making and interactions with healthcare professionals. Purposive sampling was carried out and data saturation determined sample size. A modified grounded theory approach was used and thematic analysis of interview data was carried out. Lastly, a series of structured qualitative interviews were carried out with 6 consultant neurologists. This stage was iterative in that problematic areas identified during analysis of interview data from stage 2 were presented to neurologists in infographic form to further examine issues raised. Framework analysis was carried out on neurologist interview data to examine their interpretations and potential solutions. Although there appears to be some evidence demonstrating that personalised care planning is effective for people with long term conditions, such favourable effects were not demonstrated in the context of MS. Based on the findings from the systematic reviews it is unclear whether personalised care planning is effective for people with MS and there is a clear gap in the literature examining this. Findings from the interview stages suggest there are key areas which are lacking in terms of information and decisional support. Such areas included the type and amount of information around the time of diagnosis, support when choosing disease modifying drugs and discussions about approaches outside mainstream medicine. Findings from neurologist interview data corroborated those from MS interview data, but through examination of issues raised it also highlighted some of the complexities and challenges of involving patients and enacting shared decision making in reality. This research identified key areas that require improvement for people with MS in terms of provision of the information and decisional support. Although in theory personalised care planning and shared decision making are positioned as best practice, in reality it is unclear whether they are effective or appropriate for people with MS. The way in which such approaches are enacted are complex and require careful consideration. Potential barriers and pitfalls identified within this study suggest a lack of clarity in how to respond to challenges and further investigation into how patient involvement is enacted is needed.

Medical and technological advancement in the last century has led to the unprecedented increase of the populace's quality of life and lifespan. As a result, an ever-increasing number of people live with chronic health conditions that require long-term treatment, resulting in increased healthcare costs and managerial burden to the healthcare provider. This increase in complexity can lead to ineffective decision-making and reduce care quality for the individual while increasing costs. One promising direction to tackle these issues is the active involvement of the patient in managing their care. Particularly for chronic diseases, where ongoing support is often required, patients must understand their illness and be empowered to manage their care. With the advent of smart devices such as smartphones, it is easier than ever to provide personalised digital interventions to patients, help them manage their treatment in their daily lives, and raise awareness about their illness. If such new approaches are to succeed, scalability is necessary, and solutions are needed that can act autonomously without costly human intervention. Furthermore, solutions should exhibit adaptability to the changing circumstances of an individual patient's health, needs and goals. Through the ongoing digitisation of healthcare, we are presented with the unique opportunity to develop cost-effective and scalable solutions through Artificial Intelligence (AI). This thesis presents work that we conducted as part of the project improving Medication Adherence through Person-Centered Care and Adaptive Interventions (iMedA) that aims to provide personalised adaptive interventions to hypertensive patients, supporting them in managing their medication regiment. The focus lies on inadequate medication adherence (MA), a pervasive issue where patients do not take their medication as instructed by their physician. The selection of individuals for intervention through secondary database analysis on Electronic Health Records (EHRs) was a key challenge and is addressed through in-depth analysis of common adherence measures, development of prediction models for MA and discussions on limitations of such approaches for analysing MA. Furthermore, providing personalised adaptive interventions is framed in the contextual bandit setting and addresses the challenge of delivering relevant interventions in environments where contextual information is significantly corrupted.        The contributions of the thesis can be summarised as follows: (1) Highlighting the issues encountered in measuring MA through secondary database analysis and providing recommendations to address these issues, (2) Investigating machine learning models developed using EHRs for MA prediction and extraction of common refilling patterns through EHRs and (3) formal problem definition for a novel contextual bandit setting with context uncertainty commonly encountered in Mobile Health and development of an algorithm designed for such environments.

Functional garments for physiological sensing purposes have been utilized in several disciplinesi.e. sports, firefighting, military and medical. In most of the cases textile electrodes (Textrodes)embedded in the garment are employed to monitor vital signs and other physiologicalmeasurements. Electrical Bioimpedance (EBI) is a non-invasive and effective technology that canbe used for detection and supervision of different health conditions. In some specific applicationssuch as body composition assessment EBIS has shown encouraging results proving good degreeof effectiveness and reliability. In a similar way Impedance Cardiography (ICG) is anothermodality of EBI primarily concerned with the determination of Stroke Volume SV, indices ofcontractility, and other aspects of hemodynamics.EBI technology in the previously mentioned modalities can benefit from a integration with agarment; however, a successful implementation of EBI technology depends on the goodperformance of textile electrodes. The main weakness of Textrodes is a deficient skin-electrodeinterface which produces a high degree of sensitivity to signal disturbances. This sensitivity canbe reduced with a suitable selection of the electrode material and an intelligent and ergonomicgarment design that ensures an effective skin-electrode contact area.This research work studies the performance of textile electrodes and garments for EBIspectroscopy for Total Body Assessment and Transthoracic Electrical Bioimpedance (TEB) forcardio monitoring. Their performance is analyzed based on impedance spectra, estimation ofparameters, influence of electrode polarization impedance Zep and quality of the signals using asreference Ag/AgCl electrodes. The study includes the analysis of some characteristics of thetextile electrodes such as conductive material, skin-electrode contact area size and fabricconstruction.The results obtained in this research work present evidence that textile garments with a dry skinelectrodeinterface like the ones used in research produce reliable EBI measurements in bothmodalities: BIS for Total Body Assessment and TEB for Impedance Cardiography. Textiletechnology, if successfully integrated, may enable the utilization of EBI in both modalities andconsequently implementing wearable applications for home and personal health monitoring.

Advanced information technologies promise a massive influx of individual-specific medical data. These rich sources offer great potential for an increased understanding of disease mechanisms and for providing evidence-based and personalized clinical decision support. However, the size, complexity, and biases of the data pose new challenges, which make it difficult to transform the data to useful and actionable knowledge using conventional statistical analysis. The so-called “Big Data” era has created an emerging and urgent need for scalable, computer-based data mining methods that can turn data into useful, personalized decision support knowledge in a flexible, cost-effective, and productive way. The goal of my Ph.D. research is to address some key challenges in current clinical deci-sion support, including (1) the lack of a flexible, evidence-based, and personalized data mining tool, (2) the need for interactive interfaces and visualization to deliver the decision support knowledge in an accurate and effective way, (3) the ability to generate temporal rules based on patient-centric chronological events, and (4) the need for quantitative and progressive clinical predictions to investigate the causality of targeted clinical outcomes. The problem statement of this dissertation is that the size, complexity, and biases of the current clinical data make it very difficult for current informatics technologies to extract individual-specific knowledge for clinical decision support. This dissertation addresses these challenges with four overall specific aims: Evidence-Based and Personalized Decision Support: To develop clinical decision support systems that can generate evidence-based rules based on personalized clinical conditions. The systems should also show flexibility by using data from different clinical settings. Interactive Knowledge Delivery: To develop an interactive graphical user interface that expedites the delivery of discovered decision support knowledge and to propose a new visualiza-tion technique to improve the accuracy and efficiency of knowledge search. Temporal Knowledge Discovery: To improve conventional rule mining techniques for the discovery of relationships among temporal clinical events and to use case-based reasoning to evaluate the quality of discovered rules. Clinical Casual Analysis: To expand temporal rules with casual and time-after-cause analyses to provide progressive clinical prognostications without prediction time constraints. The research of this dissertation was conducted with frequent collaboration with Children’s Healthcare of Atlanta, Emory Hospital, and Georgia Institute of Technology. It resulted in the development and adoption of concrete application deliverables in different medical settings, including: the neuroARM system in pediatric neuropsychology, the PHARM system in predictive health, and the icuARM, icuARM-II, and icuARM-KM systems in intensive care. The case studies for the evaluation of these systems and the discovered knowledge demonstrate the scope of this research and its potential for future evidence-based and personalized clinical decision support.

Nous étudions les propriétés incitatives des contrats des médecins dans différents contextes et en mobilisant différentes méthodes. Au chapitre 1, nous proposons un modèle ``principal-agent’’ dans lequel il existe une sélection adverse sur l’altruisme des agents, une responsabilité limitée et une technologie fournie par le régulateur et pouvant améliorer la qualité de l’effort des médecins. Dans un tel contexte (caractérisant le secteur de la santé avec un accès à la médecine personnalisée par exemple), nous montrons que les contrats optimaux impliquent des salaires plus élevés pour les agents altruistes et une technologie d'amélioration de l’effort de meilleure qualité pour les agents égoïstes. Au chapitre 2, nous proposons une expérience dans laquelle les médecins peuvent accéder gratuitement ou à un coût donné à des techniques de médecine personnalisée. Nous évaluons pour différents systèmes de paiement, la probabilité que les médecins prennent la décision d'un accès payant à la médecine personnalisée, et nous nous concentrons également sur la manière dont ils utilisent ces technologies, selon que leur accès est gratuit ou coûteux. Nous trouvons que les médecins ont tendance à mieux utiliser les techniques de médecine personnalisée lorsqu’ils l’ont acquis à un coût. Au chapitre 3, nous étudions les propriétés incitatives des systèmes de rémunération à la performance. En utilisant la même expérience du chapitre 2, nous trouvons que les systèmes de paiement à la performance renforcent l’attention des médecins sur ce qui est pertinent pour le patient, mais sont associés à une érosion de leur motivation intrinsèque
We study incentive properties of healthcare providers' contracts in different contexts and using a range of methods. In Chapter 1, we propose a ``regulator-agent'' model with adverse selection on altruism, limited liability and a possible effort enhancing input provided by the regulator. In such a context (characterizing the healthcare sector with a free access to personalized medicine, for example), we show that the optimal contracts entail higher salaries for the altruistic agents and higher effort-enhancing technology for selfish agents. In Chapter 2, we propose an experiment in which healthcare providers can access for free or at a given cost, personalized medicine techniques. For different payment systems, we assess the likelihood of making the decision to access personalized medicine when it is paid. We also focus on how healthcare providers use these technologies, depending on whether their access is free or costly. We find that healthcare providers tend to make better use of personalized medicine techniques when they acquire it at a cost. In Chapter 3, we study incentive properties of performance pay systems. Using the same experiment as in Chapter 2, we find that performance-based systems increase healthcare providers' attention on what is relevant to the patient. It however destroys their intrinsic motivation

This thesis studies the effects of import competition from China and Eastern Europe on the health and fertility decisions of German individuals working in manufacturing. Individuals are matched with separate measures of exposure to competition from China and Eastern Europe, respectively. To isolate exogenous supply shocks from the origin, instrumental variables for competition from each of China and Eastern Europe are constructed. Results in Chapter 1 suggest that higher import competition worsens individual health via job displacement, wage decline, shortened employment duration, increased reliance on welfare and less future orientation, with Chinese import competition affecting individuals twice as much. Health declines as individuals increase their visits to the doctor, exercise less frequently and have a higher probability of developing chronic illness. Also, there is some evidence that individuals do not tend to become disabled but may be slowly pushed into chronic illness. Findings in Chapter 2 show that import competition negatively affects the individual’s probability of having children via reduced earnings, lower satisfaction with personal income and shortened employment duration. The chapter then investigates effects of import exposure by gender. Results show that male and female fertility choices differ upon rising import competition. Higher import exposure lowers female earnings and job autonomy, which in turn generates a lower opportunity cost of work, to the point where having children would become a more rewarding alternative for female workers. By contrast, increased import exposure negatively affects male workers’ fertility through reduced earnings and employment duration.

Yes
Underpinned by a contemporary view of automotive systems as cyber-physical systems, characterised by progressively open architectures increasingly defined by their interaction with the users and the smart environment, this paper provides a critical and up-to-date review of automotive Integrated Vehicle Health Management (IVHM) systems. The paper discusses the challenges with prognostics and intelligent health management of automotive systems, and proposes a high-level framework, referred to as the Automotive Healthcare Analytic Factory, to systematically collect and process heterogeneous data from across the product lifecycle, towards actionable insight for personalised healthcare of systems.
Jaguar Land Rover funded research “Intelligent Personalised Powertrain Healthcare” 2016-2019

Conventional healthcare and the practice of medicine largely relies on the ineffective concept of one size fits all. Personalized medicine is an emerging therapeutic approach that aims to develop an advanced therapeutic technique that provides tailor-made therapy based on every individuals’ needs by delivering the right drug at the right time with the right amount of dosage. The advancement in technologies such as flexible electronics, microfluidics, biosensors, and advanced artificial intelligence can enable the realization of a truly effective personalized therapy. However, currently, there is a lack for a personalized minimally-invasive wearable closed-loop drug delivery system that is continuous, automated, conformal to the skin and cost-effective. Thus, this thesis focuses on the design, fabrication, optimization, and application of an automated personalized microfluidics drug delivery platform augmented with flexible biosensors, heaters, and expandable polymeric actuator. The platform provides precise drug delivery with spatiotemporal control over the administered dose as a response to real-time physiological changes of the individual. The system is flexible enough to be conformal to the skin and drug is transdermally administered through biocompatible microneedles. The platform includes a flexible multi-reservoir microfluidics layer, flexible and conformal heating elements, skin sensors and processing units which are powered by a lightweight battery integrated into the platform. The developed platform was fabricated using rapid, cost-effective techniques that are independent of advanced microfabrication facilities to expand its applications to low-resource setting and environments.

This dissertation focuses on the design of personalized and ubiquitous healthcare (PUH) services in the medical sector. It is proposed a new framework for structuring and deploying advanced PUH services in the right place, time and manner. According to this PUH framework, diverse types of entities (subjects and objects) are involved during the execution of each service. Each type of subject (e.g. patient, caregiver (doctor or nurse), volunteer, patient’s friend or relative, etc) or object (medical unit, medical files manager, etc) performs predefined actions according to the patient’s current health status and an agreed plan of actions. In the provision of PUH services, the permissible actions of each entity (or a group of entities) are determined by the “entity’s profile”, which is created in advance for this purpose. This work considers also the “group profile” that determines the behavior and the attributes of a specific group of entities. The PUH framework provides also mechanisms for the management of the patient’s context (environmental, living, etc) and the content of subject’s profile. Different profiling mechanisms are activated according to the subject’s type. Structurally, the proposed framework is an expansion of the framework that is utilized by the Next Generation Networks (NGN) (known as OSA/Parlay architecture) for the reliable provision of multipoint – multimedia communication services. The PUH framework distinguishes four classes of mechanisms: a) the conventional ETSI/Parlay mechanisms handling the communication among the entities that are involved during the execution of a PUH service, b) the mechanisms handling the acquisition of bio and contextual data by sensor networks deployed around the patient (e.g. Body Area Network), c) the mechanisms for the management of profiles data (e.g. availability, preferences, capabilities, care giving role, activities) and d) the security mechanisms. For the representation of these classes of mechanisms, an appropriate ontology has been created. Based on the above PUH framework, an entire profile management system is proposed. This system uses data from patient/caregivers profiles (or group profiles) in order to deploy a PUH service that will be able to support multi-party group-working schemes with well defined behaviors of all involved entities, devices and services. The technology of smart cards has selected as the appropriate technology for creating, accessing and enriching the subjects profiles. A prototype of the proposed profile management system is implemented using the cloud computing technology (Windows Azure platform). We have considered that parts of a profile are located in different service providers. The efficiency of the developed profile management system is evaluated in terms of time response in order to select the appropriate healthcare provider by simulating system's response to real world scenarios.
Η παρούσα διατριβή εστιάζεται στο σχεδιασμό εξατομικευμένων (personalized) και διάχυτων / πανταχού παρουσών (ubiquitous) υπηρεσιών τηλεϊατρικής κατάλληλων για την υγειονομική περίθαλψη χρόνια πασχόντων ασθενών (Personalized and Ubiquitous Healthcare - PUH). Προτείνεται ένα νέο πλαίσιο δημιουργίας προηγμένων υπηρεσιών PUH και παροχή των υπηρεσιών αυτών στο σωστό τόπο και χρόνο, σύμφωνα με το «προφίλ» του ασθενή. Το προφίλ αυτό περιγράφει τις δυνατές καταστάσεις όπου μπορεί να βρεθεί η υγεία του (κανονική, σε κίνδυνο, κλπ), τον τύπο υπηρεσίας PUH που θα πρέπει να λάβει ανά κατάσταση, το περιβάλλον διαβίωσής του, τις προτιμήσεις του, κλπ. Το πλαίσιο PUH επιτρέπει σε διαφορετικούς τύπους υποκειμένων (π.χ. ασθενής, πάροχος φροντίδας (γιατρός ή νοσοκόμα), εθελοντής, φίλος του ασθενή ή συγγενής, κ.λπ.) και αντικειμένων (ιατρική μονάδα, διαχειριστής ιατρικών αρχείων, κ.λ.π.) να εμπλέκονται ενεργά κατά τη διάρκεια της εκτέλεσης κάθε υπηρεσίας προσφέροντας ειδικού τύπου υπηρεσίες. Η ταυτότητα και η συμπεριφορά του κάθε υποκειμένου και αντικειμένου περιγράφεται από ένα ατομικό «προφίλ οντότητας» μέσα στο οποίο καθορίζονται: α) τα είδη των υπηρεσιών που υποστηρίζει η οντότητα ανάλογα με την κατάσταση της υγείας του ασθενή και β) οι τύποι των ενεργειών που επιτρέπεται να εκτελεί η οντότητα ανά υπηρεσία. Στη διατριβή μοντελοποιείται επίσης το «προφίλ ομάδας» που καθορίζει συνολικά τη συμπεριφορά μιας συγκεκριμένης ομάδας οντοτήτων που εμπλέκεται στην παροχή της υπηρεσίας PUH. Το πλαίσιο PUH παρέχει επίσης μηχανισμούς διαχείρισης του περιεχομένου του προφίλ του ασθενή και του κάθε εμπλεκόμενου υποκειμένου ανά υπηρεσία PUH. Διαφορετικοί μηχανισμοί προφίλ ενεργοποιούνται ανάλογα με τον τύπο του υποκειμένου. Δομικά το προτεινόμενο πλαίσιο είναι μια επέκταση του πλαισίου OSA Parlay που χρησιμοποιείται από τα δίκτυα επόμενης γενεάς (NGN) για την αξιόπιστη παροχή πολυσημειακών / πολυμεσικών υπηρεσιών επικοινωνίας. Το πλαίσιο PUH διακρίνει τέσσερις κατηγορίες μηχανισμών: α) τους συμβατικούς μηχανισμούς ETSI/ Parlay που χειρίζονται την επικοινωνία μεταξύ των οντοτήτων που λαβαίνουν μέρος κατά τη διάρκεια της εκτέλεσης μιας υπηρεσίας PUH, β) τους μηχανισμούς που χειρίζονται την απόκτηση βιοσημάτων και στοιχείων του περιβάλλοντος του ασθενή από δίκτυα αισθητήρων που εκτείνονται γύρω από τον ασθενή (π.χ. δίκτυο περιοχής σώματος), γ) τους μηχανισμούς διαχείρισης των στοιχείων των προφίλ (π.χ. διαθεσιμότητα, προτιμήσεις, ικανότητες, ρόλος, δραστηριότητες) και δ) τους μηχανισμούς ασφάλειας. Για την αναπαράσταση αυτών των κατηγοριών μηχανισμών, έχει δημιουργηθεί μια κατάλληλη οντολογία. Με βάση το ανωτέρω πλαίσιο PUH, προτείνεται ένα ολόκληρο σύστημα διαχείρισης των προφίλ. Το σύστημα αυτό χρησιμοποιεί στοιχεία από τα προφίλ των ασθενών και των παρόχων φροντίδας (ή το προφίλ της ομάδας) προκειμένου να δημιουργηθεί μια υπηρεσία PUH που να είναι σε θέση να υποστηρίξει σχήματα πολλαπλών ομάδων εργασίας, με καλά καθορισμένες συμπεριφορές όλων των εμπλεκόμενων οντοτήτων, συσκευών και υπηρεσιών. Η τεχνολογία των έξυπνων καρτών έχει επιλεγεί ως η κατάλληλη τεχνολογία για τη δημιουργία, πρόσβαση και ενημέρωση των εμπλεκομένων προφίλ. Τέλος, έχει αναπτυχθεί ένα πρωτότυπο του προτεινόμενου συστήματος διαχείρισης των προφίλ με χρήση της τεχνολογίας του υπολογιστικού σύννεφου (cloud computing) – Windows Azure platform. Έχουμε θεωρήσει ότι τα τμήματα ενός προφίλ βρίσκονται σε διαφορετικούς παρόχους υπηρεσιών. Η αποδοτικότητα του αναπτυγμένου συστήματος διαχείρισης προφίλ αξιολογείται σε σχέση με τη χρονική απόκριση προκειμένου να επιλεγεί ο αρμόδιος πάροχος υγειονομικής περίθαλψης προσομοιώνοντας τη λειτουργία και απόκριση του συστήματος σε πραγματικά σενάρια.

碩士
長庚大學
資訊管理學研究所
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Because of the specialization and complex operation, errors are easy to occur during healthcare practices, and it becomes an urgent issue to increase the accuracy of information transmission and to improve the healthcare quality. Clinical pathway and clinical guideline are the two major tools for improving healthcare quality, and health education has been shown to help prevention. In addition, there have been pushes towards the concept of patient-centered care. However, it remains a question on how to coordinate the management of patient care and personalized patient care services, as there are still room for improvement in these two areas. Using a stroke case study as an example, this thesis proposes a healthcare serviceflow management system. Combining the concept of serviceflow, this system is designed in accordance to clinical pathway. It follows the Service Oriented Architecture (SOA) and uses technologies in Web Services to accomplish integrated management. Furthermore, basing on the clinical guideline, this system uses rule-based applications to generate personalized alerts and to provide health education that is suitable to patient condition after he or she leaves the hospital. Finally, a prototype is designed to demonstrate the importance of personalized healthcare system.

A growing number of factors, including costs, technological advancements, ageing populations, and medical errors, are leading industrialized countries to invest in research on alternative solutions to improve their health-care systems and increase patients’ quality of life. Personal health systems (PHS) examplify the use of information and communication technologies that enable a paradigm shift from the traditional hospital-centered healthcare delivery model toward a preventive and person-centered approach. PHS offer the means to monitor a patient’s health using wearable, portable or implantable systems that offer ubiquitous, unobtrusive biodata acquisition, allowing remote monitoring of treatment and access to the patient’s status. Electrical bioimpedance (EBI) technology is non-invasive, quick and relatively affordable technique that can be used for assessing and monitoring different health conditions, e.g., body composition assessments for nutrition. When combined with state-of-the-art advances in sensors and textiles, EBI technologies are fostering the implementation of wearable bioimpedance monitors that use functional garments for personalized healthcare applications. This research work is focused on the development of wearable EBI-based monitoring systems for ubiquitous health monitoring applications. The monitoring systems are built upon portable monitoring instrumentation and custom-made textile electrode garments. Portable EBI-based monitors have been developed using the latest material technology and advances in system-on-chip technology. For instance, a portable EBI spectrometer has been validated against a commercial spectrometer for total body composition assessment using functional textile electrode garments. The development of wearable EBI-based monitoring units using functional garments and dry textile electrodes for body composition assessment and respiratory monitoring has been shown to be a feasible approach. The availability of these measurement systems indicates progress toward the real implementation of personalized healthcare systems.

QC 20170517

Para o sucesso das organizações, torna-se necessário valorizar os recursos humanos que delas fazem parte. Na área da saúde devem ser criadas condições para a melhoria da qualidade de vida e, consequentemente, da satisfação profissional dos seus colaboradores. A presente investigação teve como objetivo principal conhecer os fatores que influenciam a satisfação global no trabalho e as perceções sobre a qualidade de vida dos profissionais de saúde, que exercem funções no Agrupamento de Centro de Saúde (ACES) Dão Lafões, comparando as opiniões dos diversos profissionais, médicos, enfermeiros e secretários clínicos, que trabalham nas Unidades de Saúde Familiar (USF) e Unidades de Cuidados de Saúde Personalizados (UCSP). Assim através de uma investigação de cariz quantitativo, correlacional e transversal, que consistiu na aplicação de um questionário, adaptado de Correia (2012), a uma amostra constituída por 109 colaboradores, foi possível observar que tanto nas USF como nas UCSP, os médicos são a classe profissional mais satisfeita, no geral, com as condições de trabalho e a perspetiva futura de aprendizagem e progressão na carreira. A associação da idade com as dimensões em estudo (satisfação com a organização, condições de trabalho, desenvolvimento da carreira, condições de higiene, segurança, equipamentos e serviços) indica a existência de uma associação significativa positiva. Quanto à variável género, a única dimensão onde existem diferenças significativas é a das Condições de Higiene, Segurança, Equipamentos e Serviços. Relativamente à associação entre o tempo de serviço total e o tempo de serviço na USF/UCSP com as dimensões em estudo, verifica-se a existência de associações significativas negativas. Por último, confirma-se a existência de diferenças estatisticamente significativas entre as unidades de saúde em todas as dimensões em estudo. Verificando-se que é nas USF’s Grão Vasco e Montemuro onde a satisfação no trabalho apresenta resultados mais elevados. Relativamente à qualidade de vida no trabalho, a maioria dos profissionais inquiridos considera que as USF ou UCSP reúnem as condições necessárias para proporcionar uma boa qualidade de vida no trabalho.
To the success of the organisations, it is necessary to value the human resources that are part of them. In what concerns healthcare, conditions should be created to improve the quality of life and consequently, the professional satisfaction of its workers. The present research had as its main purpose to understand the factors that influence the global satisfaction of the health professionals´ work and the perceptions about the quality of life that exercise functions for Aces Dão Lafões, by comparing the opinions of the several professionals, whether they are doctors, nurses or clinical secretaries that work in the Family Health Units and Personalised healthcare Units. Through a survey adapted from Correia (2010) applied to a sample constituted by 109 collaborators, it was possible to see that both in the USF and in the UCSP, the doctors are the most satisfied professional class on a whole, owing to the working conditions, the prospect of further learning as well as the career development. In the sample being thought about, the association of age with the dimensions under consideration (satisfaction with the organisation, working conditions, career development, hygienic conditions, security, equipments and services) it shows the existence of a positive significant association. As to the association of genre with the same dimensions, the only dimension that points out the existence of meaningful differences are the ones concerning Hygienic Conditions, Security, Equipments and Services. In what regards the association between the time of total service and the time of service in USF/UCSP with the dimensions under consideration, it shows the existence of negative significant associations. Finally, it was confirmed the existence of statistically significant differences among all the health units in all the dimensions under consideration. It was verified that it is in the USF`s Grão Vasco and Montemuro where safisfaction at work presents higher results. As far as the quality of life at work is concerned most professional respondents think that the USF or UCSP gather the necessary conditions to provide a good quality of life at work.