1.

REAL-TIME MONITORING OF PHYSIOLOGICAL PARAMETERS OF OUTCANCER PATIENTS REMOTELY TO IMPROVE HEALTH CARE

A key recommendation for strategic consideration in a prophylactic Health Needs Analysis (HNA) is the urgent need to monitor, record and analyze patients flow across the different cancer treatment band. In a bid to eliminate cancerous cells, some of the surrounding cells/tissues are affected resulting in a decline in the immune system. Normal neutrophil count is between 2,000 and 7,500 per cubic millimeter of blood. Radiotherapy treatments can lower the neutrophil count. (www.cancerresearchuk.org/cancer-help). If healthcare improvement is considered important it is imperative to follow up on cancer patients upon exposing them to therapeutic radiation in order to ascertain the effects of radiation on the patients health- immune system and physiological systems. Vital signs are instructive as they are indicators of the status of cardiovascular and respiratory systems of the human body. Common vital signs that portent a high degree of possibility of implication into practical systems with a view to remotely measure and monitor on a real-time basis are: ECG ECG, EMG, EEM, temperature, blood pressure vessel resistance and blood velocity. This study involves obtaining physiological variables from out cancer patients remotely allowing nurses and physicians to track the treatment progress and status of patients information easily. Monitoring will also be real-time for clinicians as long as they are connected to the internet with a website strictly for them. My major area of interest is the comparison of controlled parameters with data that will be obtained from outpatients. I want to compare the P, Q, R, S and T- ECG waves of a normal human with that of out-cancer patients. I also plan to compare physiological results from outand HIV patients (exposure to total body radiation) with some control parameters. I consider that this research area would present an inexpensive way to monitor patients (over the internet) thereby reducing emergency hospitalizations and interventions as seen in the summary of statistics for Waikato DHB (1 July, 2011 30 June, 2012) where 21,717 did not attend outpatient clinics costing 3.25 million dollars. The 207,319 outpatients attendances figure could also be reduced.

As such, the objectives of this project are: i. To monitor remotely out-cancer patient remotely for the purpose of examining improvement. Monitoring patients in Nigeria who have received treatment in the UK is made possible. ii. iii. iv. To compare physiological controlled signals with data from patients. To eliminate the cost of outpatients attending clinics save for emergency situations. This study proposes an inexpensive means to monitor patients.

1.1

KEY RESEARCH INQURIES

What other relevant physiological parameters can be measured with regards to out-cancer patients? What sufficient statistical data can be obtained and/or derived from these parameters? How can these parameters improve health care management in Nigeria? What are the legal and ethical issues to be considered?

1.2

LITERATURE REVIEW A system is needed that will help close the gap between the level of care received

by hospitalized patients and non-hospitalized patients who must visit the doctor or other health care provider for treatment. It would be advantageous if a health care provider could regularly monitor the health status of patients, including outpatients, without requiring these patients to physically travel to and make an appointment with the health care provider unless it is absolutely necessary to do so. (Cohen 1999).

Several wireless and mobile technologies have been employed in mobile health. Examples are sensor Networks, satellite communication, ultra-wideband communication, wireless personal area networks, wireless local area networks, wireless wide area networks. Pattichis et al grouped the wireless technologies mainly used in telemedicine into GSM, satellite, and wireless LAN (WLAN). Shimizu (1999) applied analog radio techniques, digital GSM systems and satellite communications to distance medical-caring services and obtained fine results whether in physiological signals, audio voices or visual signals. The invention by Ivanov, Johannes, Stut, Wartena, which monitors the health status of patients with in-built fault detection and an intelligent unit, is made up of a communication device interfaced with a sensor device and a second communication interface for communication with a health care center. The fault detection unit generates a warning message upon failure of either the first communication interface or the second communication interface. The intelligent unit routes severe cases to a central station. Chien et al. (2005) applied information technology to medical services and developed a light and portable-type new wireless-type physiological signal measuring system using a PDA and the bluetooth technology. The system was practicable however, certain limitations were encountered namely: memory insufficiency, low system efficiency, and O/S inconsistency between of PDAs and mobile phones. Dosinas et al. (2006) proposed a system of active clothing and wearable technologies that can measure human physiological parameters. This system enables the registering of pulse and respiratory rate of workers and sending physiological data to remote center where health states are evaluated. National Aeronautics and Space Administration (NASA) in conjunction with the National Institute of Mental Health, and the Advanced Research Projects Agency funded a

research which is currently been built upon by Cybernet Medical, a division of Ann Arbor, Michigan-based Cybernet Systems Corporation. One of such research is a medical device design called MedStar which remotely monitors physiological signals of space crews. The battery-powered and portable MedStar interface device collects physiological data from offthe-shelf instruments regularly used at home. The MedStar device then securely transmits the data over a standard telephone line to the Cybernet Medical collection server, located at a hospital or a disease management companys facility, for retrieval and analysis. The process enables a health care team to immediately note changes in a patients condition and make appropriate action recommendationsresulting in fewer patient interventions and emergency hospitalizations. (www.techbriefs.com/component/content/2125). Bouharati et al. (2013) discussed the use of fuzzy Inference System to process

the medical sensors signals. The team also created intelligent software that could be used for medically for medical diagnosis . Another outpatient monitoring system invention incorporates Touch Tone telephone, central monitoring system, modem decoder, computer processor, and voice generators. According to Cohen (1999), a telephone placed on the source (patient) end is capable of generating DTMF tones, the DTMF tones representing a health condition of the patient. Signals from this telephone are sent to the sink end (a central monitoring system). The central monitoring system generates a plurality of questions concerning the health condition of the patient for the patient to answer using the plurality of keys of the touchtone telephone. Responses to these queries are stored for future use. The central monitoring system has a DTMF modem decoder receiving and decoding the DTMF tones generated by the patient. Below are the advantages of this physiological-signal measuring and monitoring communication system over other systems:

i.

No complex hardware and software will be employed though the software will be intelligent.

ii. iii. iv.

An inexpensive means of health care management. Bandwidth depends on the available bandwidth of internet connection. The range is not limited unlike the Bluetooth technology with a maximum path length of 100 meters. (www.mobileinfo.com/Bluetooth/FAQ.htm#t6)

1.3

RESEARCH METHODOLOGY The most important condiment for the successful execution of this project

depends largely on the availability of outpatients. Patients of special interest are ones who have been exposed to doses of ionizing radiation and drugs for chemotherapy. I am of the opinion that these patients will be available and willing to participate in this project as there are several radiotherapy centers in Nigeria. I plan to send emails and make telephone contacts with outpatients upon seeking their consent via the hospitals/clinics. I will prepare a 20-item self-administered questionnaire requesting for confidential communications with outpatients. Criteria under consideration: 1. Age > 16 2. English-speaking 3. Patients residing in rural areas The proposed physiological-signal measuring and monitoring communication system is diagrammatized in Fig.1.0.The system is capable of measuring and monitoring phonocardiogram, electrocardiograms, body temperature and body weight.

1.3.1

Hardware And Software Implementation

Below is a tabulation of these physiological signals of interest, measurement devices and transduction type for the devices. S/N Measurement 1 Phonocardiogram (PCG) 2 3 4 Electrocardiograms (ECG) Body Temperature Body weight Range Dynamic range 80 dB 0.5-5 mV 32 40 C 15-250 Kg Transduction Type Electrical Electrical Thermoelectric Electrical

Table 1.0: Transduction Types of Some Vital Signs Monitoring Devices

1.3.1.1 PCG Detection And Measuring Circuit A microphone will be inserted into the sound transmission tube of a traditional stethoscope (Chien et al. 2005). The resulting audio signal is preamplifier using a suitable amplifier, passed via a signal conditioning circuit and filtered. It is then applied to an analog input a patented ADC. This can be measured and monitored at the health centre as long as a link exists between the ADC and patients computer.

1.3.1.2 ECG Detection And Measuring Circuit Electrode plates of an ECG are stuck to the right arm, left arm and the left leg of the subject to obtain variable parameters. The ECG signal is amplified and filtered. Similarly, the ECG signals are fed into the ADC. Then to the computer at the patents end.

1.3.1.3

Digital Type Temperature And Measuring Circuit

A temperature responsive sensor will be employed. I will ensure that the range is agreeable with temperature range of humans. A low output impedance and linear output sensor. As described above, input signals in electric form are sent to the analog signal input of the ADC.

1.3.1.4

Digital Type Load Cell

The measurement of patients weights will be achieved by portable weighing systems with the following parameters: comprehensive error (%F.S) 0.02/0.017; Zero Balance of 1.0; and excitation voltage (V) of 9-12(DC).Continuous signals from the load cell is also fed into the ADC.

1.3.1.5

The Analog-to-Digital Converter

The physiological signals to be measured are analog in nature. ADC has ten analog inputs therefore digitization is required as it allows continuous signals to be converted to digitals signals of the same efficiency. The output signals will be directly sent to computers. All the computers at the patients end will have intelligent software installed on them. I plan to design a website that fetches data from the software.

Fig 1.0:

Physiological-Signal Measuring And Monitoring Communication System

1.4

FEASIBILITY STUDIES

According to Bowen (2009), feasibility studies are used to determine whether an intervention is appropriate for further testing; in other words, they enable researchers to assess whether or not the ideas and findings can be shaped to be relevant and sustainable. The study went further to define intervention as program, service, policy, or product that is intended to ultimately influence or change peoples social, environmental, and organizational conditions as well as their choices, attitudes, beliefs, and behaviors.

I have decided to apply five of the proposed eight general areas of focus addressed by feasibility studies: Implementation: It is my opinion that this research can be fully implemented. Raksha et al (2012, verified a similar circuit by testing on some people and got the satisfactory result. The circuit worked accordingly to the plan. The objective to build a low power, low cost, reliable, non-intrusive, and non-invasive monitoring system that would accurately measure the vital signs was achieved. Practicality: I am moved to carry out this work based on patients need for better health care services. This intervention is driven by commitment which I believe is the principal motivator. Adaptation: The system is opened to modifications wholly or in part.. It can accommodate other physiological signals as they can be measured and monitored. Integration: The home monitoring system is very flexible. Integration is very into an existing program is possible. The mobile part can be changed to GSM, satellite, or wireless LAN (WLAN).

1.41

TIME PLAN

I plan to finish my Ph.D in a total of three years. In addition to the main research I shall be writing papers and progress reports. I have decided to allocate 80% to the main task and 20 % to paper writing.

TASK

TIME (Months)

Communications with Outpatients upon seeking their consent

3.5

Sourcing and Construction of Devices for 5 outpatients (This number can be 6 Installation and Commissioning of Devices at patients place of convenience Installation and Commissioning of software Progress report Writing of Conference papers Actual Implementation Write Thesis 4 2 2.5 5 4 9

REFERENCES
Cohen K, 1999 Outpatient monitoring system. US Patent 5,633,910. Pattichis CS, Kyriacou E, Voskarides S, Pattichis MS, Istepanian R, Schizas CN, 2002 Wireless Telemedicine Systems: An Overview IEEE Antennas & Propagation Magazine, Vol.44, No.2, pp 143-153. Shimizu K, 1999 Telemedicine by Mobile Communication. IEEE Trans. Biomed. Eng. 32-44. Ivanov E, Johannes W, Stut J, Wartena F, Communication System For Monitoring The Health Status Of A Patient, Communication Device, Sensor Device And Method US Patent 20090128325. Chien JC, Tai C, 2005 A New Wireless-Type Physiological Signal Measuring System Using a PDA And The bluetooth Technology. Biomed Eng Appl Basis Comm, 7: 229-235. Dosinas A, Vaitknas M, Daunoras J, 2006 Measurement of Human Physiological Parameters in the Systems of Active Closing and Wearable Technologies. //Electronics and Electrical Engineering. No 7(71). P. 77 82. Bouharati S, Bouharati C, Benzidane F, Belmahdi M, 2013 Processing the Medical Sensors Signals Using Fuzzy Inference System. World Academy of Science, Engineering and Technology . Iyer R, Potdar R.M, Dewangan N, Rajpurohit J, 2001 Advancement of Low-cost Medicare System for the Measurement of Physiological Parameters of Human Body : International Journal of Engineering and Advanced Technology (IJEAT) ISSN: 2249 8958, Volume-1, Issue-6 . http://ww.cancer.org/treatment/treatmentsandsideeffects/treatmenttypes/radiation/under standingradiationtherapyaguideforpatientsandfamilies/understanding-radiation-therapywhat--radiation-therapy is http://www.cancerresearchuk.org/cancer-help/about-cancer/what-is-cancer/body/theimmune-system. http://www.techbriefs.com/component/content/article/2125 http://www.mobileinfo.com/Bluetooth/FAQ.htm#t6