Browsing by Author "Clarke, Malcolm"
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- ItemAn automated personalised intervention algorithm for remote patient monitoring.(2008-05-19) Fursse, Joanna; Clarke, Malcolm; Jones, Russell; Khemka, Sneh; Findlay, GenevieveAn automated personalised intervention algorithm was developed to determine when and if patients with chronic disease in a remote monitoring programme required intervention for management of their condition The effectiveness of the algorithm has so far been evaluated on 29 patients It was found to be particularly effective in monitoring newly diagnosed patients patients requiring a change in medication as well as highlighting those that were not conforming to their medication Our approach indicates that RPM used with the intervention algorithm and a clinical protocol can be effective in a primary care setting for targeting those patients that would most benefit from monitoring
- ItemClinical ICT systems: augmenting case management.(2002-09-04) Baldwin, Lynne P; Clarke, Malcolm; Jones, RussellIn order to improve the diagnosis and subsequent care given to patients health care workers involved in the management of their care as well as the treatment itself are increasingly looking at the role that information and communication technologies ICTs can play in supporting the complex interactions between patient doctor or nurse consultant and medical equipment Effective communication both amongst health care workers and between health care workers and their patients in both primary and secondary care is vital ICTs can play an important role in this In this paper possible interpretations given to the term telemedicine are discussed and then attention is turned to the challenges involved in human interaction and the role of ICTs An example of a clinical ICT system AIDMAN is used to illustrate how face to face interaction has usefully been supported by way of a virtual consultation which facilitates remote medical diagnosis and can provide improved case management
- ItemDeveloping a standard for personal health devices based on 11,073.(2008-05-19) Clarke, MalcolmThis paper describes the process and outcome of the efforts to develop a new standard for Personal Health Data PHD based on the existing 11 073 family of standards for medical devices It identifies the requirements for a standard that is to be applied to small devices with limited resources of processor memory and power and that will use short range wireless technology It describes how existing components of 11 073 such the Domain Information Model and nomenclature have been used and adapted to create the new standard
- ItemDeveloping a standard for personal health devices based on 11073.(2007-11-16) Clarke, Malcolm; Bogia, Douglas; Hassing, Kai; Steubesand, Lars; Chan, Tony; Ayyagari, DeepakThis paper describes the process and outcome of the efforts to develop a new standard for Personal Health Data PHD based on the existing 11073 family of standards for medical devices It identifies the requirements for a standard that is to be applied to small devices with limited resources of processor memory and power and that will use short range wireless technology It describes how existing components of 11073 such the Domain Information Model and nomenclature have been used and adapted to create the new standard
- ItemAn e-Health approach to managing vascular surgical patients.(2007-01-25) Hands, Linda J; Clarke, Malcolm; Mahaffey, Wendy; Francis, Heather; Jones, Russell WThe objective of this study was to investigate an e health approach to managing patients presenting with vascular type symptoms A pilot study of a prospective cohort of patients referred from a single general practitioner practice of 5700 patients using electronic referral assessment by a practice nurse and teleconferencing facilities as an adjunct to normal referral and management practice was designed and conducted Thirty eight patients aged 30 93 years old median 72 years were enrolled in the study between March 2001 and July 2004 Twelve patients had leg ulceration and 12 complained of leg pain The remainder had a range of symptoms potentially vascular in nature All but 1 patient had an initial teleconsultation This initial teleconsultation lasted a median of 11 minutes interquartile range 9 minutes min 59 seconds sec 12 min 43 sec For 10 patients this was their only contact with the hospital One patient had teleconsultation follow up only 26 patients attended the hospital for vascular laboratory studies or angiography and 8 of these went on to have radiological and or surgical intervention Three patients attended the outpatient department for follow up all other follow ups were managed via the teleclinic Overall 57 standard outpatient attendances in these patients were replaced by teleconsultations Common vascular type symptoms can be satisfactorily evaluated across a telelink with the aid of a practice nurse and baseline patient data transmitted electronically Decisions can be made regarding the need for further investigation and attendance in outpatient clinic can be largely eliminated
- ItemEarly experience in using telemonitoring for the management of chronic disease in primary care.(2008-04-23) Fursse, Joanna; Clarke, Malcolm; Jones, Russell; Khemka, Sneh; Findlay, GenevieveWe have investigated the use of telemonitoring in three long term conditions chronic heart failure CHF type 2 diabetes and essential hypertension Participants were provided with a home telemonitoring unit for a 12 week period and entered physiological data each day The data were sent automatically via the participant s telephone line to a server and could be viewed via a web browser An intervention algorithm was developed to improve the accuracy with which patients requiring intervention were recognized compared to existing systems based on a simple threshold Thirty patients completed the 12 week trial One patient dropped out giving data on 29 patients mean age 70 years 17 women The algorithm prompted a clinical intervention in 11 patients 38 The average time that elapsed before the first intervention was 47 days SD 21 Primarily the interventions 72 resulted in changes to medication and health advice The results suggest that four weeks is sufficient time in which to recognize the need to intervene clinically and that in 12 weeks it is possible to effect a change towards a target
- ItemThe effect of telemedicine on consultation time.(2003-09-03) Baldwin, Lynne; Clarke, Malcolm; Hands, Linda; Knott, Mary; Jones, RussellWe have implemented an evidence based referral for primary care patients in dermatology cardiology and peripheral vascular disease Telemedicine clinics bring together a district nurse patient and vascular surgeon to discuss diagnosis management and care During a 30 month study a total of 30 patients participated in telemedicine clinics The mean consultation time fell from 23 to 10 min In parallel the type of consultation changed from dermatology to vascular surgery Nineteen patients participated in vascular telemedicine clinics over the last 16 months of the study The average consultation time was 10 min SD 1 which included discussion of the case and negotiation of its management The average consultation time in the equivalent outpatient clinic in the same hospital for the same consultant was 15 min The acquisition of the relevant information in primary care could lead to a reduction of 75 in outpatient clinic appointments
- ItemEvaluation of the practical feasibility and acceptability of home monitoring in residential homes.(2005-07-22) Bratan, Tanja; Clarke, Malcolm; Jones, Russell; Larkworthy, Andrew; Paul, RayThree residential homes to the north west of London with their associated medical centres were equipped with telemonitors to measure several variables including seven lead electrocardiogram blood pressure oxygen saturation heart rate temperature and respiration The monitors could be operated by non medical personnel After recording the data were transmitted via the Internet to a server A total of 24 patients with a variety of chronic conditions were monitored regularly for a period of one year Data transmission was found to be unreliable on occasions and was improved by extending the wireless network in the homes Data access and presentation were considered acceptable although suggestions for minor changes were made No discernible impact on disease management diagnosis or care was observed as a result of the monitoring However interviewees saw several potential benefits and patient acceptance was very good The monitoring was found to be generally acceptable and feasibility was considered to have been largely proven
- ItemGlobal forum on telemedicine: connecting the world through partnerships.(2008-06-23) Pak, Hon S; Brown-Connolly, Nancy E; Bloch, Carolyn; Clarke, Malcolm; Clyburn, Conrad; Doarn, Charles R; Llewellyn, Craig; Merrell, Ronald C; Montgomery, Kevin; Rasche, Jeanette; Sullivan, BradleyThe American Telemedicine Association ATA held the Global Forum on Telemedicine Connecting the World Through Partnerships in September 2007 with sponsorship by the Telemedicine and Advanced Technology Research Center TATRC U S Army Medical Research and Materiel Command USAMRMC The goal was to bring together key stakeholders in global healthcare outreach to explore a flexible framework and sustainable business model that can leverage telemedicine and information technology IT to expand healthcare services internationally Dr Hon S Pak President of the ATA opened the forum with a call for collaboration and partnership and encouraged continued international dialogue to create a framework that leverages the telemedicine community to improve global disparity in healthcare Keynote addresses included speakers from the World Health Organization UN and United Nations UN Global Alliance for Information and Communities Technologies and Development GAID Presentations from 15 government and nongovernment aid organizations NGOs and 12 international programs covered 5 key areas 1 NGO perspective 2 governmental military programs 3 financial sustainability 4 disaster response and 5 emerging opportunities The forum resulted in an International Roadmap for Action that was developed by the authors based on the presentations and interactions from the 335 attendees and establishing a set of priorities and actions to improve healthcare using telemedicine and IT Recommendations include 1 continued dialogue in creating a telemedicine framework 2 identification and leverage of resources 3 provision of education to funding organization and expand training programs to build competency in the healthcare workforce 4 alignment of international policy to support integration of telemedicine into country plans and support cross country partnerships 5 development of communications infrastructure and 6 integration of telemedicine into disaster relief programs
- ItemHuman and organisational aspects of remote patient monitoring in residential care homes.(2007-11-30) Bratan, Tanja; Choudrie, Jyoti; Clarke, Malcolm; Jones, Russell; ,Demographic changes in the population with a growing proportion of elderly people make the efficient and effective provision of healthcare for this age group an increasingly important issue We examine the organisational and human aspects of introducing a Remote Patient Monitoring RPM system that uses wireless and broadband networks into three residential care homes in the UK Stakeholders were identified and semi structured one to one interviews were carried out in order to identify issues deemed most important to each group The work is novel as it requires examination of the issues of communication between healthcare workers in several primary and secondary care organisations The key finding was the need to identify the changes in working practice and interpersonal communication A key factor in particular was the change in relationships staff in the remote centre needing to learn to seek support when reporting and requesting assistance for a problem and for the staff at the health centres to respond appropriately
- ItemThe impact of remote patient monitoring in managing silent myocardial infarction in a residential home setting.(2007-06-22) Clarke, Malcolm; Bratan, Tanja; Kulkarni, Sadhana; Jones, RussellWe describe the impact of a remote patient monitoring RPM system implemented in residential care homes
- ItemAn integrated nursing and telemedicine approach to vascular care.(2002-09-09) Bangs, Iris; Clarke, Malcolm; Hands, Linda; Jones, Russell; Knott, Mary; Mahaffey, WendyWe have developed a telemedicine approach to vascular care for patients being managed in primary care District nurses visit patients in their homes Clinical information and digital photographs can be sent by email to the vascular surgeon for assessment Where appropriate a preliminary teleconsultation between the patient and a vascular surgeon with the nurse in attendance is held at the primary care centre and the management of the patient is agreed This may include referral to surgery Over eight months six patients with diabetes and peripheral ulcers participated in the vascular telemedicine clinic The average consultation time was 12 min SD 4 which included discussion of the case and negotiation of its management Important outcomes of the new system were the ability to schedule patients for rapid referral and to have completed the management of the case during the teleconsultation
- ItemIntegrated Telehealth and Telecare for Monitoring Frail Elderly with Chronic Disease.(0000-00-00) Gokalp, Hulya; de Folter, Joost; Verma, Vivek; Fursse, Joanna; Jones, Russell; Clarke, MalcolmOBJECTIVE To investigate the potential of an integrated care system that acquires vital clinical signs and habits data to support independent living for elderly people with chronic disease MATERIALS AND METHODS We developed an IEEE 11073 standards based telemonitoring platform for monitoring vital signs and activity data of elderly living alone in their home The platform has important features for monitoring the elderly unobtrusive simple elderly friendly plug and play interoperable and self integration of sensors Thirty six 36 patients in a primary care practice in the United Kingdom mean standard deviation age 82 10 years with congestive heart failure CHF or chronic obstructive pulmonary disease COPD were provided with clinical sensors to measure the vital signs for their disease blood pressure BP and weight for CHF and oxygen saturation for COPD and one passive infrared PIR motion sensor and or a chair bed sensor were installed in a patient s home to obtain their activity data The patients were asked to take one measurement each day of their vital signs in the morning before breakfast All data were automatically transmitted wirelessly to the remote server and displayed on a clinical portal for clinicians to monitor each patient An alert algorithm detected outliers in the data and indicated alerts on the portal Patient data have been analyzed retrospectively following hospital admission emergency room visit or death to determine whether the data could predict the event RESULTS Data of patients who were monitored for a long period and had interventions were analyzed to identify useful parameters and develop algorithms to define alert rules Twenty of the 36 participants had a clinical referral during the time of monitoring 16 of them received some type of intervention The most common reason for intervention was due to low oxygen levels for patients with COPD and high BP levels for CHF Activity data were found to contain information on the well being of patients in particular for those with COPD During exacerbation the activity level from PIR sensors increased slightly and there was a decrease in bed occupancy One subject with CHF who felt unwell spent most of the day in the bedroom CONCLUSIONS Our results suggest that integrated care monitoring technologies have a potential for providing improved care and can have positive impact on well being of the elderly by enabling timely intervention Long term BP and pulse oximetry data could indicate exacerbation and lead to effective intervention physical activity data provided important information on the well being of patients However there remains a need for better understanding of long term variations in vital signs and activity data to establish intervention protocols for improved disease management
- ItemAn investigation into the use of 3G mobile communications to provide telehealth services in rural KwaZulu-Natal.(2015-01-31) Clarke, Malcolm; Mars, MauriceBACKGROUND We investigated the use of third generation 3G mobile communications to provide telehealth services in remote health clinics in rural KwaZulu Natal South Africa MATERIALS AND METHODS We specified a minimal set of services as our use case that would be representative of typical activity and to provide a baseline for analysis of network performance Services included database access to manage chronic disease local support and management of patients to reduce unnecessary travel to the hospital emergency care up to 8 h for an ambulance to arrive e mail access to up to date information Web and teleclinics We made site measurements at a representative set of health clinics to determine the type of coverage general packet radio service GPRS 3G its capabilities to support videoconferencing H323 and Skype Microsoft Redmond WA and audio Skype and throughput for transmission control protocol TCP to gain a measure of application performance RESULTS We found that none of the remote health clinics had 3G service The GPRS service provided typical upload speed of 44 kilobits per second Kbps and download speed of 64 Kbps This was not sufficient to support any form of videoconferencing We also observed that GPRS had significant round trip time RTT in some cases in excess of 750 ms and this led to slow start up for TCP applications CONCLUSIONS We found audio was always so broken as to be unusable and further observed that many applications such as Web access would fail under conditions of very high RTT We found some health clinics were so remote that they had no mobile service 3G where available had measured upload speed of 331 Kbps and download speed of 446 Kbps and supported videoconferencing and audio at all sites but we frequently experienced 3G changing to GPRS We conclude that mobile communications currently provide insufficient coverage and capability to provide reliable clinical services and would advocate dedicated wireless services where reliable communication is essential and use of store and forward for mobile applications
- ItemThe need for a global telemedicine society.(2007-05-23) Clarke, Malcolm
- ItemA new monitoring service for long term residential care.(2005-03-07) Bratan, Tanja; Jones, Russell; Clarke, MalcolmeVital a European funded project aims to investigate the issues in the provision of vital signs monitoring services in the community For the UK pilot services to monitor the vital signs of patients in residential care homes by remote health care workers have been established In particular the aim was to allow the resident s own GP to observe the ECG blood pressure SpO2 temperature and respiration whilst still in the health centre and be able to advise on the most appropriate action should a crisis occur As outcomes this pilot project was designed to determine feasibility channels of communication between key players and assess the technology Trials have been under way for four months and preliminary results are promising Residential home staff have commented on the extra level security they feel in being able to summon medical support for residents for whom they may have concern Patient s relatives have also commented on the reassurance they experience from knowing that the resident is being monitored
- ItemNurses' and community support workers' experience of telehealth: a longitudinal case study.(2014-04-17) Sharma, Urvashi; Clarke, MalcolmIntroduction of telehealth into the healthcare setting has been recognised as a service that might be experienced as disruptive This paper explores how this disruption is experienced
- ItemOptimum design of remote patient monitoring systems.(2007-10-23) Bratan, Tanja; Clarke, MalcolmRemote patient monitoring RPM of physiological measurements offers the potential to provide high quality care to elderly chronically and acutely ill people in their home environment while making effective use of healthcare resources However despite its clearly demonstrated potential RPM has not become an integrated part of patient care so far In this paper we undertake an extensive systematic literature review to identify the typical setup of RPM projects and services in the UK We then propose a solution for a clinically and organizationally more integrated service which is based in primary care Key to the design is the involvement of other healthcare services such as social care the emergency department of a hospital and out of hours General Practitioner services and also the involvement of the patient and their carer s This allows a team based approach with information sharing across different healthcare sectors and offers maximum continuity of care for the patient
- ItemA reference architecture for telemonitoring.(2005-03-07) Clarke, MalcolmThe Telecare Interactive Continuous Monitoring System exploits GPRS to provide an ambulatory device that monitors selected vital signs on a continuous basis Alarms are sent when parameters fall outside preset limits and accompanying physiological data may also be transmitted The always connected property of GPRS allows continuous interactive control of the device and its sensors permitting changes to monitoring parameters or even enabling continuous monitoring of a sensor in emergency A new personal area network PAN has been developed to support short range wireless connection to sensors worn on the body including ECG and finger worn SpO2 Most notable is use of ultra low radio frequency to reduce power to minimum The system has been designed to use a hierarchical architecture for sensors and derived signals such as HR from ECG so that each can be independently controlled and managed Sensors are treated as objects and functions are defined to control aspects of behaviour These are refined in order to define a generic set of abstract functions to handle the majority of functions leaving a minimum of sensor specific commands The intention is to define a reference architecture in order to research the functionality and system architecture of a telemonitoring system The Telecare project is funded through a grant from the European Commission IST programme
- ItemA systematic review of technical evaluation in telemedicine systems.(2008-03-25) Clarke, Malcolm; Thiyagarajan, Chinnaya AWe conducted a systematic review of the literature to critically analyse the technical evaluation and assessment frameworks that have been applied to telemedicine systems A total of 47 articles met the inclusion criteria Subjective methods were predominantly used for technical evaluation 59 e g Likert scale Those including objective measurements 41 were mainly restricted to simple metrics such as network time delays Only 3 papers included a rigorous standards based objective approach Our investigation has been unable to determine a definitive standards based telemedicine evaluation framework that exists in the literature that may be applied systematically to assess and compare telemedicine systems We conclude that work needs to be done to address this deficiency