K4Health
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This Digital Health Resource Library houses three legacy collections previously maintained by the Knowledge for Health (K4Health) Project. K4Health’s work was made possible by the support of the American People through the United States Agency for International Development (USAID) . K4Health was supported from 2008-2019 by USAID's Office of Population and Reproductive Health, Bureau for Global Health, under cooperative agreements with the Johns Hopkins University. K4Health was implemented by the Johns Hopkins Center for Communication Programs (CCP) in collaboration with FHI 360, Management Sciences for Health (MSH), and IntraHealth International. The K4Health Project ended in September 2019.
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Browsing K4Health by Subject "Acute or emergency"
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- ItemActive tremor cancellation by a "smart" handheld vitreoretinal microsurgical tool using swept source optical coherence tomography.(2012-11-28) Song, Cheol; Gehlbach, Peter L; Kang, Jin UMicrosurgeons require dexterity to make precise and stable maneuvers to achieve surgical objectives and to minimize surgical risks during freehand procedures This work presents a novel common path swept source optical coherence tomography based smart micromanipulation aided robotic surgical tool SMART that actively suppresses surgeon hand tremor The tool allows enhanced tool tip stabilization more accurate targeting and the potential to lower surgical risk Freehand performance is compared to smart tool assisted performance and includes assessment of the one dimensional motion tremor in an active microsurgeon s hand Surgeon hand tremor the ability to accurately locate a surgical target and maintain tool tip offset distances were all improved by smart tool assistance
- ItemAdvanced communication infrastructure for pre-hospital EMS care.(2008-11-12) Orthner, Helmuth; Mazza, Giovanni; Mazza, Giovanni Giorgio; Shenvi, Rohit; Battles, MarcieThe traditional communication infrastructure of the pre hospital Emergency Medical System EMS is limited to voice communication using radio or cell phone technologies With the emergence of 3rd Generation wireless networks 3G and enhanced mobile devices capable of data communication e g mobile tablets PDAs with cell phones or cell phones with PDA capabilities the voice communication can be enhanced with interactive data messaging and perhaps even with interactive video communication However video requires substantially more bandwidth which 4th Generation 4G systems are promising However their availability is limited We present an infrastructure that allows dynamic selection of the best data transport mode in the pre hospital EMS environment
- ItemAlbumin testing in urine using a smart-phone.(2013-10-02) Coskun, Ahmet F; Nagi, Richie; Sadeghi, Kayvon; Phillips, Stephen; Ozcan, AydoganWe demonstrate a digital sensing platform termed Albumin Tester running on a smart phone that images and automatically analyses fluorescent assays confined within disposable test tubes for sensitive and specific detection of albumin in urine This light weight and compact Albumin Tester attachment weighing approximately 148 grams is mechanically installed on the existing camera unit of a smart phone where test and control tubes are inserted from the side and are excited by a battery powered laser diode This excitation beam after probing the sample of interest located within the test tube interacts with the control tube and the resulting fluorescent emission is collected perpendicular to the direction of the excitation where the cellphone camera captures the images of the fluorescent tubes through the use of an external plastic lens that is inserted between the sample and the camera lens The acquired fluorescent images of the sample and control tubes are digitally processed within one second through an Android application running on the same cellphone for quantification of albumin concentration in the urine specimen of interest Using a simple sample preparation approach which takes 5 min per test including the incubation time we experimentally confirmed the detection limit of our sensing platform as 5 10 g mL 1 which is more than 3 times lower than the clinically accepted normal range in buffer as well as urine samples This automated albumin testing tool running on a smart phone could be useful for early diagnosis of kidney disease or for monitoring of chronic patients especially those suffering from diabetes hypertension and or cardiovascular diseases
- ItemAmbulance 12-lead electrocardiography transmission via cell phone technology to cardiologists.(2010-10-20) Hsieh, Jui-Chien; Lin, Bo-Xuan; Wu, Feng-Ren; Chang, Pei-Chann; Tsuei, Yi-Wei; Yang, Chung-ChiThis study demonstrates transmission of 12 lead electrocardiography ECG in an ambulance to the cell phone of the attendant emergency medical technician and then to the hospital and to cell phones of off site cardiologists The emergency medical technician cell phone receives Extensible Markup Language files generated by a Phillips Extensible Markup Language ECG instrument via Wi Fi based wireless network and then sends them to an ECG processing server at the hospital over the mobile telephone network After reducing ECG noises and artifacts the server converts files to Digital Imaging and Communications in Medicine based ECG reports stored in Picture Archiving and Communication System These reports are sent to the cell phones of off site cardiologists Consequently on site Emergency Department physicians and off site cardiologists can discuss ECG reports via Picture Archiving and Communication System on their computers or cell phones to prepare for the most appropriate treatment while the patient is on the way to the hospital In conclusion this 12 lead ECG transmission e technology expands the functions of a 12 lead ECG instrument and facilitates more efficient prehospital cardiac care
- ItemAnalysis of the inter- and intra-observer agreement in radiographic evaluation of wrist fractures using the multimedia messaging service.(2012-12-03) Ferrero, Andrea; Garavaglia, Guido; Gehri, Roland; Maenza, Ferruccio; Petri, Gianfranco John; Fusetti, CesareBACKGROUND Orthopaedic surgeons are often asked to evaluate X rays of patients admitted to the Accident and Emergency Department with the suspicion of a wrist fracture or in the case of an evident fracture to decide the correct treatment The aim of this study was to evaluate the feasibility of a correct interpretation of the images of injured wrists on the screen of a last generation mobile phone in order to evaluate if the specialist could make the right diagnosis and choose the correct treatment METHODS Five orthopaedic and one hand surgeons have evaluate the X rays of 67 patients who sustained an injury to their wrist In the case of fracture they were asked to classify it according to the AO and Mayo classification systems The evaluation of the images was accomplished through the PACS and using a mobile phone at a different time In order to check the inter and intra observer reliability the same pattern was followed after a few months RESULTS The mobile phone showed basically the same agreement between the observers highlighting the worsening of the inter and intra observer reliability with the increment of the variables considered by a classification system CONCLUSIONS The present paper confirms that a last generation mobile phone can already be used in the clinical practise of orthopaedic surgeons on call who could use it as a useful device in remote or poorly served areas for a rapid and economic consultation LEVEL OF EVIDENCE The level of evidence of this case is economic and decision analysis level 2
- ItemApplying mobile and pervasive computer technology to enhance coordination of work in a surgical ward.(2007-10-03) Hansen, Thomas Riisgaard; Bardram, Jakob ECollaboration coordination and communication are crucial in maintaining an efficient and smooth flow of work in an operating ward This coordination however often comes at a high price in terms of unsuccessfully trying to get hold of people disturbing telephone calls looking for people and unnecessary stress To accommodate this situation and to increase the quality of work in operating wards we have designed a set of pervasive computer systems which supports what we call context mediated communication and awareness These systems use large interactive displays video streaming from key locations tracking systems and mobile devices to support social awareness and different types of communication modalities relevant to the current context In this paper we report qualitative data from a one year deployment of the system in a local hospital Overall this study shows that 75 of the participants strongly agreed that these systems had made their work easier
- ItemAn assessment of the iPad 2 as a CT teleradiology tool using brain CT with subtle intracranial hemorrhage under conventional illumination.(2013-07-09) Park, Joon Bum; Choi, Hyuk Joong; Lee, Jeong Hun; Kang, Bo SeungWe examined the potential of the iPad 2 as a teleradiologic tool for evaluating brain computed tomography CT with subtle hemorrhage in the conventional lighting conditions which are common situations in the remote CT reading The comparison of the clinician s performance was undertaken through detecting hemorrhage by the iPad 2 and the clinical liquid crystal display LCD monitor We selected 100 brain CT exams performed for head trauma or headache Fifty had subtle radiological signs of intracranial hemorrhage ICH while the other 50 showed no significant abnormality Five emergency medicine physicians reviewed these brain CT scans using the iPad 2 and the LCD monitor scoring the probability of ICH on each exam on a five point scale Result showed high sensitivities and specificities in both devices We generated receiver operating characteristic curves and calculated the average area under the curve of the iPad 2 and the LCD 0 935 and 0 900 Using the iPad 2 and reliable internet connectivity clinicians can provide remote evaluation of brain CT with subtle hemorrhage under suboptimal viewing condition Considering the distinct advantages of the iPad 2 the popular out of hospital use of mobile CT teleradiology would be anticipated soon
- ItemAtrial fibrillation with symptoms other than palpitations: incremental diagnostic sensitivity with at-home tele-cardiology assessment for emergency medical service.(2012-05-22) Brunetti, Natale Daniele; De Gennaro, Luisa; Pellegrino, Pier Luigi; Dellegrottaglie, Giulia; Antonelli, Gianfranco; Di Biase, MatteoBACKGROUND Clinical presentation of atrial fibrillation AF is usually represented by palpitations nevertheless atypical presentation of AF with symptoms other than palpitations may be not uncommon in elderly patients This study therefore aimed to evaluate incremental diagnostic value of tele medicine at home assessment in patients who called emergency medical service EMS METHODS A total of 27 841 consecutive EMS patients referred for suspected heart disease underwent ECG assessment with a mobile ECG recorder device ECGs were transmitted with mobile phone support to a tele cardiology hub active 24 7 where a cardiologist read the ECGs Rate of prevalence of AF age of patients and symptoms were analysed RESULTS AF was diagnosed in 11 67 of patients who underwent ECG examination Typical symptoms were complained by 6 56 of whole patients only 14 05 of patients with AF rate of subjects with AF and typical symptoms significantly decreased with age Under65 years 29 58 65 75 years 17 06 75 years 10 35 p Under 0 001 Number needed to diagnose an AF with atypical presentation number needed to treat decreased from 45 Under65 years to 9 65 75 years and 5 75 years p Under 0 001 Tele cardiology support increased the rate of at home diagnosis of AF from two fold in 40 year olds up to four fold 60 year olds and seven fold 70 year olds CONCLUSIONS AF with symptoms other than palpitations is a common finding in elderly EMS patients Tele cardiology support improves the sensitivity of diagnosis of AF in elderly EMS patients and is useful in at home identification of subjects with AF and atypical presentation
- ItemBehavioral support to parents through a cellular-phone website that provides the degree of urgency for medical attention of a child.(2013-08-07) Iwasawa, Mariko; Miyahara, Jyutaro; Noriaki, Terasawa; Nozue, Hiroki; Sumazaki, RyoWhen a child suddenly falls ill the child s family assesses if medical attention is required immediately However even in case of minor illnesses it is not possible to approach a medical institution after consultation hours and the burden on doctors from overtime emergency medical examinations becomes a social problem This study proposes the use of a cellular phone website that provides information about the degree of urgency for medical attention to parents who can choose the child s symptoms on the cellular phone website regardless of the time or place Therefore through this study parents experimentally evaluated the cellular phone website also the effectiveness of this method as a behavioral support for parents was also evaluated When an advice about the degree of urgency for a child s treatment was taken from the cellular phone website the parents felt relieved Thus the distress faced by pediatricians may change completely
- ItemThe benefit of smart phone usage in liver organ procurement.(2011-04-04) Croome, Kris P; Shum, Jeff; Al-Basheer, Mamoun A; Kamei, Hideya; Bloch, Michael; Quan, Douglas; Hernandez-Alejandro, RobertoA 56 year old man was on the transplant list with end stage liver disease secondary to hepatitis C when a donor liver became available at a location 545 km away The procurement team consisting of a senior and junior fellow went on the retrieval while the staff surgeon remained in the hospital with the recipient At the time of organ procurement a suspicious lesion was identified in the left lateral lobe The transplant fellows took intraoperative pictures of the lesion with a smart phone and sent them to the staff surgeon for advice A teleconsultation facilitated by images sent from the smart phone took place over the next 22 min The decision was made to proceed with the transplant as it was felt that the lesion could be resected from the liver allograft Had the fellows not been able to interact with the staff surgeon in real time during the surgery there is a high likelihood that the organ would have been rejected by the staff surgeon due to the unexpected finding The patient s postoperative course was relatively uneventful with no evidence of infection The patient was discharged from hospital and continues to do well We expect that the role of smart phones in remote consultation will continue to expand in future
- ItemBig brother could actually help quite easily: telementored "just-in-time" telesonography of the FAST over a smartphone.(2011-08-29) Crawford, Innes; Tiruta, Corina; Kirkpatrick, Andrew W; Mitchelson, Mark; Ferguson, James
- ItemCan mobile health technologies transform health care?(2013-12-11) Steinhubl, Steven R; Muse, Evan D; Topol, Eric J
- ItemCan mobile phone data improve emergency response to natural disasters?(2011-09-15) Gething, Peter W; Tatem, Andrew J
- ItemCellular technology improves transmission success of pre-hospital electrocardiograms.(2013-11-01) Larochelle, Nicholas; O'Keefe, Michael; Wolfson, Daniel; Freeman, KalevSTUDY OBJECTIVE In rural settings long distances and transport times pose a challenge for achieving early reperfusion goals in patients with ST elevation myocardial infarction STEMI This study investigated the association between the method of pre hospital 12 lead ECG transmission radio transmission vs cellular phone transmission and the success of transmission and legibility of 12 lead ECGs in a rural setting METHODS Observational study of pre hospital 12 lead ECG transmission to the emergency department ED in a predominantly rural area Success of transmission and the legibility of the 12 lead ECG were analyzed to identify barriers to 12 lead ECG transmission and reasons for failed transmission RESULTS Emergency medical services performed ECGs on 1140 patients 917 of which they attempted to transmit including 43 cases requiring emergent catheterization Twelve lead ECG transmission was successful in 236 70 of 337 radio attempts and 441 76 of 580 cellular attempts difference 6 0 95 CI 1 1 12 1 Legibility increased from 164 49 of 337 radio attempts to 389 67 of 580 cellular attempts difference 18 4 95 CI 11 8 24 9 CONCLUSION The success of transmission and legibility of 12 lead ECGs was significantly higher with cellular technology by emergency medical service agencies in comparison to radio transmission In rural settings with lengthy transport times utilization of cellular technology for transmission of pre hospital 12 lead ECGs may improve door to balloon times for STEMI patients
- ItemCommunication latencies of Apple push notification messages relevant for delivery of time-critical information to anesthesia providers.(2013-07-24) Rothman, Brian S; Dexter, Franklin; Epstein, Richard HBACKGROUND Tablet computers and smart phones have gained popularity in anesthesia departments for educational and patient care purposes VigiVU is an iOS application developed at Vanderbilt University for remote viewing of perioperative information including text message notifications delivered via the Apple Push Notification APN service In this study we assessed the reliability of the APN service METHODS Custom software was written to send a message every minute to iOS devices iPad iPod Touch and iPhone via wireless local area network WLAN and cellular pathways 24 hours a day over a 4 month period Transmission and receipt times were recorded and batched by days with latencies calculated as their differences The mean SEM and the exact 95 upper confidence limits for the percent of days with 1 prolonged 100 seconds latency were calculated Acceptable performance was defined as mean latency Under30 seconds and 0 5 of latencies 100 seconds Testing conditions included fixed locations of devices in high signal strength locations RESULTS Mean latencies were Under1 second for iPad and iPod devices WLAN and Under4 seconds for iPhone cellular Among 173 000 iPad and iPod latencies none were 100 seconds For iPhone latencies 0 03 0 01 were 100 seconds The 95 upper confidence limits of days with 1 prolonged latency were 42 iPhone and 5 to 8 iPad iPod CONCLUSIONS The APN service was reliable for all studied devices over WLAN and cellular pathways and performance was better than third party paging systems using Internet connections previously investigated using the same criteria However since our study was a best case assessment testing is required at individual sites considering use of this technology for critical messaging Furthermore since the APN service may fail due to Internet or service provider disruptions a backup paging system is recommended if the APN service were to be used for critical messaging
- ItemComputer laboratory notification system via short message service to reduce health care delays in management of tuberculosis in Taiwan.(2011-05-31) Chen, Tun-Chieh; Lin, Wei-Ru; Lu, Po-Liang; Lin, Chun-Yu; Lin, Shu-Hui; Lin, Chuen-Ju; Feng, Ming-Chu; Chiang, Horn-Che; Chen, Yen-Hsu; Huang, Ming-ShyanBACKGROUND We investigated the impacts of introducing an expedited acid fast bacilli AFB smear laboratory procedure and an automatic real time laboratory notification system by short message with mobile phones on delays in prompt isolation of patients with pulmonary tuberculosis TB METHODS We analyzed the data for all patients with active pulmonary tuberculosis at a hospital in Kaohsiung Taiwan a 1 600 bed medical center during baseline January 2004 to February 2005 and intervention July 2005 to August 2006 phases RESULTS A total of 96 and 127 patients with AFB positive TB was reported during the baseline and intervention phases respectively There were significant decreases in health care system delays ie laboratory delays reception of sputum to reporting P Under 001 response delays reporting to patient isolation P 045 and interval from admission to patient isolation P Under 001 during the intervention phase Significantly fewer nurses were exposed to each patient with active pulmonary TB during the intervention phase P 039 CONCLUSION Implementation of expedited AFB smear laboratory procedures and an automatic real time laboratory mobile notification system significantly decreased delays in the diagnosis and isolation of patients with active TB
- ItemDesign and evaluation of a wireless electronic health records system for field care in mass casualty settings.(2011-10-19) Lenert, L A; Kirsh, D; Griswold, W G; Buono, C; Lyon, J; Rao, R; Chan, T CBACKGROUND There is growing interest in the use of technology to enhance the tracking and quality of clinical information available for patients in disaster settings This paper describes the design and evaluation of the Wireless Internet Information System for Medical Response in Disasters WIISARD MATERIALS AND METHODS WIISARD combined advanced networking technology with electronic triage tags that reported victims position and recorded medical information with wireless pulse oximeters that monitored patient vital signs and a wireless electronic medical record EMR for disaster care The EMR system included WiFi handheld devices with barcode scanners used by front line responders and computer tablets with role tailored software used by managers of the triage treatment transport and medical communications teams An additional software system provided situational awareness for the incident commander The WIISARD system was evaluated in a large scale simulation exercise designed for training first responders A randomized trial was overlaid on this exercise with 100 simulated victims 50 in a control pathway paper based and 50 in completely electronic WIISARD pathway All patients in the electronic pathway were cared for within the WIISARD system without paper based workarounds RESULTS WIISARD reduced the rate of the missing and or duplicated patient identifiers 0 vs 47 pUnder0 001 The total time of the field was nearly identical 38 20 vs 38 23 IQR 26 53 1 05 32 vs 18 55 57 22 CONCLUSION Overall the results of WIISARD show that wireless EMR systems for care of the victims of disasters would be complex to develop but potentially feasible to build and deploy and likely to improve the quality of information available for the delivery of care during disasters
- ItemDesign and implementation of a real-time clinical alerting system for intensive care unit.(2002-12-04) Chen, Hsiao-Ting; Ma, Wun-Chun; Liou, Der MingNowadays many hospitals use clinical information systems CIS to improve patient health care and information management CIS retrieves and manages patient information such as patient administration laboratory data and medications Specialized CIS especially Intensive Care Unit ICU CIS needs to handle more additional information How to process and make use of this enormous amount of physiologic data generated by ICU is a significant topic in CIS design We have designed and implemented a real time clinical alerting system for ICU which executes alert algorithms on the database records of 63 ICU physiologic parameters The user can create various alert rules with our rule editor to supervise the values or trends of these parameters When an alert condition on a specific patient is detected the system notices the clinicians in charge with mobile phones or pagers With this functionality up to date patient information is provided for clinicians inverted exclamation mark use in judging the patient inverted exclamation mark s condition and making treatment decisions
- Item[Design of the chest belt wireless health monitoring terminal for the old based on MSP430].(2012-08-24) Qin, Xiuzhen; Wang, Feng; Zhou, Ping; Xu, HaijingA real time monitoring terminal for the empty nest elderly based on extracting fabric type sensor and acceleration sensor combined with Bluetooth wireless communication technology is proposed When the system detects arrhythmia and falls of the elderly and then start the wireless bluetooth communication complete the information interaction with mobile phone gateway device so as to implement the rescue
- ItemThe design of the m-health service application using a Nintendo DS game console.(2011-03-09) Lee, Sangjoon; Kim, Jungkuk; Lee, MyounghoIn this article we developed an m health monitoring system using a Nintendo DS game console to demonstrate its utility The proposed system consists of a biosignal acquisition device wireless sensor network base station for signal reception from the sensor network and signal conversion according to Internet protocol personal computer display program and the Nintendo DS game console The system collects three channel electrocardiogram ECG signals for cardiac abnormality detection and three axis accelerometer signals for fall detection of a person The collected signals are then transmitted to the base station through the wireless sensor network where they are transformed according to the transmission control protocol Internet protocol TCP IP and sent to the destination IP through Internet network To test the developed system the collected signals were displayed on a computer located in different building through wired Internet network and also simultaneously displayed on the Nintendo DS game console connected to Internet network wirelessly The system was able to collect and transmit signals for more than 24 h without any interruptions or malfunctions showing the possibility of integrating healthcare monitoring functions into a small handheld type electronic device developed for different purposes without significant complications It is expected that the system can be used in an ambulance nursing home or general hospital where efficient patient monitoring from long distance is necessary