scholarly journals An Unsupervised Behavioral Modeling and Alerting System Based on Passive Sensing for Elderly Care

2020 ◽  
Vol 13 (1) ◽  
pp. 6
Author(s):  
Rui Hu ◽  
Bruno Michel ◽  
Dario Russo ◽  
Niccolò Mora ◽  
Guido Matrella ◽  
...  
Keyword(s):  
Health Status ◽  
Healthcare Service ◽  
Behavioral Science ◽  
Elderly Care ◽  
Elderly Person ◽  
Real Life ◽  
Healthcare Services ◽  
Living Condition ◽  
Care Providers ◽  
Remote Healthcare

Artificial Intelligence in combination with the Internet of Medical Things enables remote healthcare services through networks of environmental and/or personal sensors. We present a remote healthcare service system which collects real-life data through an environmental sensor package, including binary motion, contact, pressure, and proximity sensors, installed at households of elderly people. Its aim is to keep the caregivers informed of subjects’ health-status progressive trajectory, and alert them of health-related anomalies to enable objective on-demand healthcare service delivery at scale. The system was deployed in 19 households inhabited by an elderly person with post-stroke condition in the Emilia–Romagna region in Italy, with maximal and median observation durations of 98 and 55 weeks. Among these households, 17 were multi-occupancy residences, while the other 2 housed elderly patients living alone. Subjects’ daily behavioral diaries were extracted and registered from raw sensor signals, using rule-based data pre-processing and unsupervised algorithms. Personal behavioral habits were identified and compared to typical patterns reported in behavioral science, as a quality-of-life indicator. We consider the activity patterns extracted across all users as a dictionary, and represent each patient’s behavior as a ‘Bag of Words’, based on which patients can be categorized into sub-groups for precision cohort treatment. Longitudinal trends of the behavioral progressive trajectory and sudden abnormalities of a patient were detected and reported to care providers. Due to the sparse sensor setting and the multi-occupancy living condition, the sleep profile was used as the main indicator in our system. Experimental results demonstrate the ability to report on subjects’ daily activity pattern in terms of sleep, outing, visiting, and health-status trajectories, as well as predicting/detecting 75% hospitalization sessions up to 11 days in advance. 65% of the alerts were confirmed to be semantically meaningful by the users. Furthermore, reduced social interaction (outing and visiting), and lower sleep quality could be observed during the COVID-19 lockdown period across the cohort.

scholarly journals AI-Enabled Elderly Care Robot

2020 ◽  
Author(s):  
Iram Noreen ◽  
Adeel Akbar ◽  
Uzair Siddiqui
Keyword(s):  
Health Care ◽  
Humanoid Robot ◽  
Elderly Care ◽  
Elderly Person ◽  
Humanoid Robots ◽  
Object Identification ◽  
Daily Routine ◽  
Care Providers ◽  
Future Health ◽  
Data Set

The increasing average human age and a growing number of old age population over the globe have emerged the need for automation in the health care domain. Eventually, health care robots will contribute to manage the workload of the care providers in the future health care domain. Elderly people face a major challenge to identify and pronounce names of daily use objects and different family and friends due to dementia-related issues. One of the many tasks by AI-Enabled elderly care humanoid robots will be communication with such patients. They will aid them to remember objects and persons they find difficult to identify and recognize due to dementia. This study has investigated the potential of the JD humanoid robot for object identification in such a scenario. The study has presented a prototype AI-Enabled elderly care robot that can aid elder persons to identify different objects. The robot is trained on ImageNet data set for object identification. Further, a personalized data set comprising of faces of different persons labeled by names of family and friends are also used to train robots for family recognition aid. The JD Humanoid robot captures an image of an object/person and also tracks it as the object/face moves. It identifies input images and outputs in audio format the name of the object/person to guide the elderly person. The third feature of the robot is the notifications of daily routine tasks for elder people like reminders for prayer, exercise walk, and medicine intake. Testing results have shown an object and person identification with 95% accuracy.

scholarly journals Disagreement Between Self-Reporting and Objective Diagnosis in Chronic Diseases Among Omanis 2008

2018 ◽  
Vol 10 (5) ◽  
pp. 97 ◽  
Author(s):  
Hilal Al Shamsi ◽  
Abdullah Almutairi
Keyword(s):  
Chronic Disease ◽  
Health Status ◽  
Chronic Diseases ◽  
Healthcare Service ◽  
Quality Of Healthcare ◽  
Healthcare Services ◽  
Objective Measurement ◽  
The Self ◽  
Positive Agreement

Background: Health specialists and researchers usually collect information about chronic diseases from self-reports. However, the accuracy of self-reports has been questioned as it relies on the respondents’ understanding of pathological conditions and their ability to recall information. Accordingly, an objective diagnosis is generally regarded as a more precise indication of the presence of disease.Objective: The study objectives were to determine the extent of disagreement between self-reporting and objective diagnosis, identify contributory factors to the discrepancy, and examine the effects of the incongruity on quality of healthcare services and health status.Methods: Secondary data from the most recent Oman World Health Survey (OWHS), for which data were readily available (2008), were analysed in the current study. This was the most recent survey conducted in Oman to date as collection of the data for the subsequent survey only commenced in February 2017 and is still in progress. Agreement between the self-reporting of chronic disease (diabetes mellitus and hypertension) and the results of medical examinations was calculated using kappa (ϰ) statistics. Sociodemographic risk factors for the self-reported and objective measurement of disease were identified (second objective). Univariate analysis was measured initially to determine associations between the variables and the outcome. Thereafter, significant variables were included in multivariate analysis performed using logistic regression. The impact of disagreement on quality of healthcare service and health status (third objective) was also examined using the chi-square test in relation to health service quality and health status variables.Results: Of 3524 Oman adults, aged ≥ 20 years (48% males), agreement between the self-reported and objective measurement of chronic disease was found to be poor to moderate (ϰ = 0.001-0.141). The highest agreement was observed for diabetes mellitus (ϰ = 0.402) and the lowest was found for asthma (ϰ = 0.000). Socioeconomic or demographic characteristics were not significantly associated with the degree of agreement attained between the methods used to measure chronic disease (p = > 0.050), except for sex, age and region. The discrepancy did not significantly impact on familial support (i.e., financial, social, health, physical and personal), the responsiveness of the health system, and household income or expenditure. However, the disagreement was associated with significant effects for other healthcare service and health status variables, i.e., quality of life and health service utilisation (p = < 0.050). It was found that people with the chronic disease and aware of their health status (positive agreement), and those with negative objective measure but positive self-reported disease (negative disagreement), were more likely to access healthcare services (83% of who had a positive agreement for chronic lung disease) and to be satisfied with the quality of care provided (82% of who had a negative disagreement for hypertension), compared to those who assumed they were healthy but had a chronic disease.Conclusions and Recommendations: Although agreement between the self-reported and objective measurement of chronic disease was found to be poor to moderate, we found that some socioeconomic demographic characteristics, such as educational and economic level, did not affect the agreement of measure tools for hypertension and diabetes, except for sex, age and region. Contrary to our expectations, disagreement between objective and self-reported measures in chronic diseases appears not to significantly impact on the quality of healthcare services and health status. The high use of health care services in participants with positive disagreement may result in unnecessary healthcare service costs required to treat chronic diseases. The implications on health services use and planning of this disagreement in the diagnosis of chronic diseases have been scarcely addressed in the literature, therefore, the results from our study need to be taken as a first approximation to this issue. Provided the unexpected results, we recommend examining closely the integrity of the dataset before giving full value about the validity of them.

scholarly journals Implementation of a Psychiatric Nurse-Led Outreach Service at Older Adult Homes: A Hong Kong Experience

2015 ◽  
pp. 1-6
Author(s):  
Yuen-ling Fung
Keyword(s):  
Primary Care ◽  
Older Adult ◽  
Healthcare Service ◽  
Planning Process ◽  
Underserved Populations ◽  
Mental Healthcare ◽  
Primary Care Providers ◽  
Healthcare Services ◽  
Care Providers ◽  
Healthcare Needs

This article reports on the implementation of a local pioneering psychiatric nurseled service that was designed to address the unmet mental healthcare needs of adults residing at older adult homes. It also describes features of potentially wider relevance to nurses interested in developing healthcare service for other underserved populations. We highlight the view that the crux of developing a successful service involves understanding existing service gaps, grasping the pulse of changing healthcare service policies, involving relevant stakeholders in the planning process, validating service outcomes, and seeking support from management. A central goal of the service was to enhance the accessibility of mental healthcare services to people with unmet needs. This model of service is preferred by service users (both the care providers and the residents in the older adult homes), is efficient in terms of providing prompt psychiatric nursing interventions, is able to supply primary care providers with ractical advice in response to their enquiries, and helps primary care providers to detect and manage the mental healthcare needs of older adults.

HOME CARE IN OUTPATIENT CARE – STATE AND DEVELOPMENT IN BULGARIA

2018 ◽  
Vol 28 (2) ◽  
pp. 571-574
Author(s):  
Ivanka Stambolova ◽  
Stefan Stambolov
Keyword(s):  
Home Care ◽  
Outpatient Care ◽  
Care Service ◽  
Elderly Care ◽  
Care Center ◽  
Elderly Person ◽  
Chronically Ill ◽  
The Elderly ◽  
Legal Regulation ◽  
Health And Social Care

In outpatient care the home care, including hospices, is recognized as a model for providing quality, cost-effective and charitable care. The focus is mainly on the care that helps everyday lifeof the patient as well as the relatives, rather than on treatment, and in most cases it takes place in the patients' home. In Europe, in recent years there has been a real "boom" in home care due to demographic processes linked to increased needs for elderly care and chronically ill under the conditions of limited financial resources.In outpatient medical care in our country by means of a national framework contract there are regulated visits to the patient's home by a doctor, as well as visits by medical staff employed by him - nurse, midwife, medical assistant / paramedic / for manipulation, counseling and monitoring. At the same time there is no regulated legal activity in the Republic of Bulgaria, which is essentially the subject of home care.Since 1994 „Caritas“ has carried out the "Home Care" service, which provides a complex - health and social care for over 360 sick adults in a place where the elderly person feels the most comfortable - in their own home. „Caritas Home Care“ is provided by mobile teams of nurses and social assistants who visit the elderly at home and provide them with the necessary care according to their health and social needs.With the establishment of the first „Home Care Center“ in Lozenets region, Sofia, with the support of the PHARE ACCESS program in 2003, the Bulgarian Red Cross introduces in Bulgaria an integrated model for provision of health care and social services in the home of adults, chronically ill and people with permanent disabilities. To date, there are a number of problems in home care related to the realization of home care for patients in need in out-of-hospital settings: lack of legal regulation for home care, lack of qualified staff in outpatient care; lack of organization and structures for care; unsettled funding and the inability of the part of the population that is most in need of care to pay for it, there is no regulation to control the activity. Although home care began over 20 years ago, our country is yet to make its way to the European program called „Home care in Europe“.

Health Care Services and EU Competition Law

2020 ◽  
Author(s):  
Okeoghene Odudu
Keyword(s):  
Market Power ◽  
Healthcare Service ◽  
Health Care Services ◽  
Service Providers ◽  
Competition Law ◽  
Healthcare Services ◽  
System Matrix ◽  
Member States ◽  
Eu Member States ◽  
Care Services

This chapter investigates how, within a number of European Union (EU) Member States, competition law has been used to address problems of market power in the healthcare services sector. It summarizes the relevant EU and national competition laws and considers the experience of applying those laws to providers of healthcare services. The chapter is chiefly concerned with healthcare services in England, although examples are drawn for other EU Member States. Examination of the English experience provides a view of the use of competition law to address market power problems in most elements of the health system matrix. The chapter then considers three challenges that emerge from that experience of using competition law to address problems of market power in healthcare service markets. The first challenges the applicability of competition law to healthcare service providers operating in each or every element of the healthcare system matrix. The second, accepting applicability, questions the appropriateness of the substantive rules to healthcare services. The third, a battle of authority and autonomy, considers whether decisions made by healthcare service providers should be subject to external review and the type of review that competition law offers.

scholarly journals Oral Health Status, Knowledge, and Behaviours of People with Diabetes in Sydney, Australia

2021 ◽  
Vol 18 (7) ◽  
pp. 3464
Author(s):  
Prakash Poudel ◽  
Rhonda Griffiths ◽  
Amit Arora ◽  
Vincent W. Wong ◽  
Jeff R. Flack ◽  
...  
Keyword(s):  
Health Status ◽  
Oral Health ◽  
Diabetes Care ◽  
Health Knowledge ◽  
Oral Health Status ◽  
Care Providers ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Oral Health Knowledge ◽  
Sydney Australia

This study assessed self-reported oral health status, knowledge, and behaviours of people living with diabetes along with barriers and facilitators in accessing dental care. A cross sectional survey of 260 patients from four public diabetes clinics in Sydney, Australia was undertaken using a 35-item questionnaire. Data were analysed using SPSS software with descriptive and logistic regression analyses. More than half (53.1%) of respondents reported having dental problems which negatively impacted their related quality of life. Less than half (45%) had adequate oral health knowledge. Only 10.8% reported receiving any oral health information in diabetes care settings, which had higher odds of demonstrating adequate oral health knowledge (AOR, 2.60; 95% CI, 1.06–6.34). Similarly, 62.7% reported seeing a dentist in the last 12 months. Having private health insurance (AOR, 3.70; 95% CI, 1.85–7.40) had higher odds of seeing a dentist in the past 12 months. Dental costs were a major contributor to avoiding or delaying dental visit. Patients living with diabetes have unmet oral health needs particularly around the awareness of its importance and access to affordable dental services. Diabetes care providers can play a crucial role in this area by promoting oral health to their patients.

scholarly journals Potential of standard perinatal data for measuring maternal integrity in childbirth

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
C Miani ◽  
S Batram-Zantvoort ◽  
O Razum
Keyword(s):  
Real Life ◽  
Healthcare Setting ◽  
Demographic Variables ◽  
Care Providers ◽  
Birth Process ◽  
Standard Data ◽  
Obstetric Violence ◽  
Relevant Variables ◽  
Perinatal Data ◽  
Birth Centres

Abstract Background Measuring the phenomenon of violation of maternal integrity in childbirth (e.g. obstetric violence) relies in part on the completeness of maternity care providers' data. The population coverage and linkage possibilities that they provide make for a great untapped potential. Although violation of integrity is a complex phenomenon best measured with dedicated instruments, standard data provide details about the birth and care received. Relevant variables include justifications of medical procedures (e.g. episiotomy) and characteristics of the birth process (e.g. length of labour). Demographic variables can be used for intersectional analyses to track potential discrimination -a dimension of violation of integrity in childbirth. Methods Using a baseline questionnaire and perinatal data obtained from hospitals, birth centres and midwifes in the BaBi study (Germany), we compared the completeness of integrity-relevant variables across providers and depending on the demographic and clinical characteristics of the women. We investigated potential for analysis from an intersectional perspective. Results Our analyses included 908 births, of which 32 outside hospital. There were 634 vaginal birth vs. 274 caesarean sections. We found poor reporting on demographic variables, in particular with regard to the 'region of origin' variable (correct origin recorded for half of the migrants). There was better reporting by midwives than by hospitals for “soft indicators”, such as the position of the women during birth (100% vs. 87.6%). Conclusions Putting more emphasis on completeness of standardised data could increase their potential for research. Healthcare setting, organisational culture and working conditions might determine what is judged important in terms of reporting; therefore, targeted education may improve this process. Next, we will interview care providers to understand data collection constraints and priorities and potential reporting bias in real-life settings.

scholarly journals Robots for Elderly Care in the Home: A Landscape Analysis and Co-Design Toolkit

2021 ◽  
Author(s):  
Gianluca Bardaro ◽  
Alessio Antonini ◽  
Enrico Motta
Keyword(s):  
Large Scale ◽  
Daily Life ◽  
Elderly Care ◽  
Real Life ◽  
Robotic Platform ◽  
Holistic View ◽  
Personal Assistants ◽  
Healthcare Interventions ◽  
The Impact ◽  
The Eu

AbstractOver the last two decades, several deployments of robots for in-house assistance of older adults have been trialled. However, these solutions are mostly prototypes and remain unused in real-life scenarios. In this work, we review the historical and current landscape of the field, to try and understand why robots have yet to succeed as personal assistants in daily life. Our analysis focuses on two complementary aspects: the capabilities of the physical platform and the logic of the deployment. The former analysis shows regularities in hardware configurations and functionalities, leading to the definition of a set of six application-level capabilities (exploration, identification, remote control, communication, manipulation, and digital situatedness). The latter focuses on the impact of robots on the daily life of users and categorises the deployment of robots for healthcare interventions using three types of services: support, mitigation, and response. Our investigation reveals that the value of healthcare interventions is limited by a stagnation of functionalities and a disconnection between the robotic platform and the design of the intervention. To address this issue, we propose a novel co-design toolkit, which uses an ecological framework for robot interventions in the healthcare domain. Our approach connects robot capabilities with known geriatric factors, to create a holistic view encompassing both the physical platform and the logic of the deployment. As a case study-based validation, we discuss the use of the toolkit in the pre-design of the robotic platform for an pilot intervention, part of the EU large-scale pilot of the EU H2020 GATEKEEPER project.

scholarly journals Are Essential Women’s Healthcare Services Fully Covered? A Comparative Analysis of Policy Documents in Shanghai and New York City from 1978–2017

2021 ◽  
Vol 18 (8) ◽  
pp. 4261
Author(s):  
Qingyu Zhou ◽  
Qinwen Yu ◽  
Xin Wang ◽  
Peiwu Shi ◽  
Qunhong Shen ◽  
...  
Keyword(s):  
New York ◽  
New York City ◽  
Women's Health ◽  
York City ◽  
Healthcare Service ◽  
Healthcare Services ◽  
Coverage Rate ◽  
Policy Documents ◽  
Service Coverage ◽  
The Relationship

This study aimed to analyze the changes in the 10 major categories of women’s healthcare services (WHSs) in Shanghai (SH) and New York City (NYC) from 1978 to 2017, and examine the relationship between these changes and maternal mortality ratio (MMR). Content analysis of available public policy documents concerning women’s health was conducted. Two indicators were designed to represent the delivery of WHSs: The essential women’s healthcare service coverage rate (ESCR) and the assessable essential healthcare service coverage rate (AESCR). Spearman correlation was used to analyze the relationship between the two indicators and MMR. In SH, the ESCR increased from 10% to 90%, AESCR increased from 0% to 90%, and MMR decreased from 24.0/100,000 to 1.01/100,000. In NYC, the ESCR increased from 0% to 80%, the AESCR increased from 0% to 60%, and the MMR decreased from 24.7/100,000 to 21.4/100,000. The MMR significantly decreased as both indicators increased (p < 0.01). Major advances have been made in women’s healthcare in both cities, with SH having a better improvement effect. A common shortcoming for both was the lack of menopausal health service provision. The promotion of women’s health still needs to receive continuous attention from governments of SH and NYC. The experiences of the two cities showed that placing WHSs among policy priorities is effective in improving service status.

scholarly journals Rationale and design of the Novel Uses of adaptive Designs to Guide provider Engagement in Electronic Health Records (NUDGE-EHR) pragmatic adaptive randomized trial: a trial protocol

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Julie C. Lauffenburger ◽  
Thomas Isaac ◽  
Lorenzo Trippa ◽  
Punam Keller ◽  
Ted Robertson ◽  
...  
Keyword(s):  
Older Adults ◽  
Usual Care ◽  
Behavioral Science ◽  
Inappropriate Prescribing ◽  
The Novel ◽  
Care Providers ◽  
Health Records ◽  
Electronic Health ◽  
Stage 1

Abstract Background The prescribing of high-risk medications to older adults remains extremely common and results in potentially avoidable health consequences. Efforts to reduce prescribing have had limited success, in part because they have been sub-optimally timed, poorly designed, or not provided actionable information. Electronic health record (EHR)-based tools are commonly used but have had limited application in facilitating deprescribing in older adults. The objective is to determine whether designing EHR tools using behavioral science principles reduces inappropriate prescribing and clinical outcomes in older adults. Methods The Novel Uses of Designs to Guide provider Engagement in Electronic Health Records (NUDGE-EHR) project uses a two-stage, 16-arm adaptive randomized pragmatic trial with a “pick-the-winner” design to identify the most effective of many potential EHR tools among primary care providers and their patients ≥ 65 years chronically using benzodiazepines, sedative hypnotic (“Z-drugs”), or anticholinergics in a large integrated delivery system. In stage 1, we randomized providers and their patients to usual care (n = 81 providers) or one of 15 EHR tools (n = 8 providers per arm) designed using behavioral principles including salience, choice architecture, or defaulting. After 6 months of follow-up, we will rank order the arms based upon their impact on the trial’s primary outcome (for both stages): reduction in inappropriate prescribing (via discontinuation or tapering). In stage 2, we will randomize (a) stage 1 usual care providers in a 1:1 ratio to one of the up to 5 most promising stage 1 interventions or continue usual care and (b) stage 1 providers in the unselected arms in a 1:1 ratio to one of the 5 most promising interventions or usual care. Secondary and tertiary outcomes include quantities of medication prescribed and utilized and clinically significant adverse outcomes. Discussion Stage 1 launched in October 2020. We plan to complete stage 2 follow-up in December 2021. These results will advance understanding about how behavioral science can optimize EHR decision support to improve prescribing and health outcomes. Adaptive trials have rarely been used in implementation science, so these findings also provide insight into how trials in this field could be more efficiently conducted. Trial registration Clinicaltrials.gov (NCT04284553, registered: February 26, 2020)

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