Medicinteknikdagarna Stockholm, 2013

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1 Medicinteknikdagarna Stockholm, 2013 ABSTRAKT

2 Egentillverkning, ansvar, hur och vem? Session 1B Moderator: Heikki Teriö 2 2

3 Egentillverkning En viktig del av innovationsarbetet Jimmy Johansson 1, Maria Olsson 1, Lisa Nilsson 1, Thomas Hajdu 1, Jörgen Larsson 1, Anna Grahn 2 1 Medicinsk teknik, Skånes universitetssjukhus, Lund/Malmö, Sverige. 2 Bild- och funktionsdiagnostiskt centrum Lund, Skånes universitetssjukhus, Lund/Malmö, Sverige. Inledning Möjligheten till tidig klinisk användning av medicinsktekniska produkter är ett viktigt verktyg i landstingens innovationsarbete. Att tidigt kunna använda egentillverkade produkter i begränsad omfattning ökar sannolikheten för att det är slutanvändarens behov som styr utformningen av framtidens produkter. Positivt resultat från den begränsade kliniska användningen ökar produktens trovärdighet längs den ofta krokiga vägen genom olika innovationssystem och minimerar de ständigt återkommande frågorna om hur vidare det finns ett reellt behov eller ej. Bakgrund Medicinsk teknik vid Skånes universitetssjukhus har sedan ett tiotal år tillbaka arbetat med egentillverkning inom elektronik och finmekanik i stor utsträckning. Det har funnits rutiner och mallar för riskhantering och uppfyllandet av väsentliga krav men det har saknats fullständiga processer för t.ex. produktutveckling samt en övergripande kvalitetsmanual. Under åren ökade antalet projekt inom medicinteknisk mjukvara avsevärt och arbetet med att hitta effektiva metoder för detta inledes. Vi uppmärksammade att de flesta regulatoriska aktiviteterna genomfördes precis innan driftsättning, vilken inte bara ger en obalans i arbetsbelastning utan även minskar möjligheten att förbättra produkten utifrån t.ex. riskanalysens resultat. Vi såg därmed över ordningsföljden för de övergripande aktiviteterna och framförallt riskhanteringsprocessen som ofta förbrukar mycket resurser. Under arbetet med att skapa effektivare processer för riskhantering och användbarhet använde vi ett projekt som tog fram en applikation för beräkning och presentation av blodflöde i hjärnan som pilot där en professor och två doktorander från Lunds Tekniska Högskola följde och studerade analysarbetet. Resultatet har publicerats i tre artiklar 1,2,3 och använts för att förbättra processerna för riskhantering och användbarhet på Medicinsk teknik. Utveckling Till följd av att Medicinsk teknik utökat sin verksamhet inom forskning och utveckling och nu leder eller medverkar i flertalet stora forsknings- och utvecklingsprojekt har det varit möjligt och tvunget att lägga ännu större fokus kvalitetsarbetet. Nyligen har upprättandet av ett fullständigt kvalitetsledningssystem för utveckling av medicintekniska produkter enligt ISO avslutats. Detta arbete gjordes stegvis genom inledande utbildningsinsatser inom vår verksamhet, därefter i form av praktiskt genomförande i mindre skala samt analys av ett företags ISO-certifierade ledningssystem. Slutligen upprättade en mindre grupp bestående av processanvariga och slutanvändare ett fullständigt ledningssystem som ska passa väl in vår verksamhet. Ledningssystemet innehåller alla tillämpliga processer men pekar i så stor utsträckning som möjligt på befintliga rutiner inom verksamheten. Processen för användarvänlighet och utveckling av medicinteknisk programvara, enligt EN respektive EN 62304, har t.ex. använts inom det VINNOVA-finansierade projektet IT-stöd för Avancerad Cancervård i Hemmet där stort fokus lagts på användarvänlighet och det har genomförts aktiviteter med både vårdpersonal och patienter. Det fortsatta arbetet med ledningssystemet på Medicinsk teknik kommer inrikta sig på att lägga respektive projekt på korrekt nivå samt att utbildning av berörda medarbare sker i den takt som krävs. Resultat och slutsatser Ledningssystem ger universitetssjukhuset kontroll över egentillverkade produkter och öppnar upp för innovativt arbete i flera olika projekt. I projektet IT-stöd för Avancerad Cancervård i Hemmet har flera mindre delar av det medicintekniska systemet tagits i kliniskt bruk. I flera fall har den kliniska användningen endast varit ett mellansteg för att få feedback för den framtida utvecklingen. T.ex. används teknik, som i framtiden är tänkt att flyttas hem till patienterna, kliniskt inom sjukhuset. Det kan även handla om begränsad användning där man har bra kontroll på utbildningsgrad osv. Därmed kan man på ett säkert och relativt tidigt stadium få återkoppling på produktens utformning och prestanda från tänkta slutanvändare. Medicinsk teknik verksamhet inom forskning och utveklings stödjer även regionens innovations- och testbäddsverksamhet med detta arbetssätt, vilket med stor sannolikhet medför att fler och bättre produkter når marknaden och därmed tillgodoser fler användare och patienters behov. 1 "A Case Study on Software Risk Analysis and Planning in Medical Device Development" 2 Introducing Usability Testing in the Risk Management Process in Software Development 3 "A Case Study on Software Risk Analysis in Medical Device Development" 3

4 Ehälsa/IKT I Session 2B Moderator: Bengt Arne Sjöqvist 4

5 2B2 E-Health in Developing Countries to Manage illnesses through Patient Education and Empowerment of Rural Health Workers Mannan Mridha 1, Björn Erik Erlandsson 1, Mohammad Islam 2, Mandalika B. Srinivas 3 1 School of Technology and Health, the Royal Institute of Technology, Stockholm, Sweden 2 BSM Medical University, Dhaka, Bangladesh 3 Birla Institute of Technology and Sciences, BITS, Hyderabad, India 1 Introduction In developing countries, the vast majority of the people are living in the rural areas with limited access to quality care. In fact, village doctors with limited training, community health workers, unqualified allopathic providers and drug store sales people are largely responsible for providing the rural medical care. Severe sufferings and increased healthcare cost of the patients are caused due to either inadequate information, choice of drugs and treatment strategies etc. Some relatively well to do rural patients go the cities for medical care. The private hospitals and clinics offer adequate services but are out of reach for the common people. The government hospitals and clinics are affordable for all but offer poor quality services. Most of the medical equipment are imported but often do not function effectively due poor quality of service and maintenance Physicians order expensive and sometimes unnecessary investigations because they receive incentives for their referrals from the diagnostic centers. Doctors' tendency to prescribe fashionable and expensive drugs or irrational drugs with limited therapeutic value is also of concern for patients care and safety. Currently a burning question is how to bring a rapid improvement for rural people in the developing countries that have no or limited access to safe health care? The application of Internet and Communication Technology, ICT in healthcare is growing rapidly in an attempt to find cost effective solutions for providing quality healthcare (1). We are working with the integration of smart, affordable medical devices with telemedicine using modern ICT tools, for improving the rural health care situations (2). 2 Method The rural people depend on village doctors and paramedics. But they have limited capacity for providing relevant healthcare. In order to improve health care facilities and achieve health equity and patient safety, we together with the local partners are using Innovative, Relevance, Acceptability, Affordability and Effective ICT tools to address some of the health problems in rural areas. We are working to improve rural health workers capacity, quality and performance by creating enabling environment to provide services that are. Our actions include development of a) reliable, robust and cost effective medical devices, b) proper education and training to use the diagnostic equipment, c) connectivity to the medical experts for disease prevention and treatment advice and d) health education to teach how to prevent and treat health problems which routinely afflict them. We have developed and deployed reliable and affordable diagnostic devices integrated with the communication systems and have developed care services nearest to the homes that have the capacity to diagnose the common chronic illnesses, formulate in consultation with distant specialists a Home-care Plan, follow-up care, identify secondary risks and make referrals. We have also initiated to organize Health Clubs to create scope for collective approach for management of these illnesses that ensures access and patient education and empowerment. Female health worker are visiting rural women at the homes with: i) relevant and user-friendly health care content to educate to manage health, ii) portable and affordable diagnostic and iii) communication platform to connect the health workers and patients with medical experts for advice. 3 Results We find our model of e-health activities to be appropriate for India and Bangladesh and believe to be suitable for other resource-constrained countries. Rural people find great satisfaction from the face to face video-consultation with the medical experts. They appreciate the just in time, cost-effective and quality treatment without any need for travelling. This has greatly reduced the earlier errors due to wrong diagnosis or wrong medication or too much medication for a too long time. Some other positive impacts of our work are: a) Better monitoring of the progress of health programmes and achievements of health MDGs. b) Increased understanding of the importance of e-health by the policy-makers c) Rural doctors and paramedics benefit from a satisfying professional experience thanks to connectivity to medical experts and avoiding harmful mistakes. This rural e-health service decreases their professional isolation, reduce number of unnecessary referrals and facilitate for continuous education and empowerment, d) A creative environment of health around the Point of Care to strengthen the confidence of the community for seeking health and start sharing the responsibility of health care by all stake holders; 4 Discussions While working with ICT tools for empowering the rural people in Bangladesh and India, some of the challenges that we faced include, unreliability of electricity supply, weak internet backbone, high internet access cost, financial constraints preventing the purchase of an appropriate number and type of ICT equipment, unavailability of adequate number of computer-literate employees to implement e-health programme, resistance to changes. Work should be intensified to: a) raise awareness of existing e-health tools and services, b) develop an knowledge exchange network to share practical experiences on the application and impact of e-health initiatives, c) create an e-health information resource to support the needs of the rural people and d) promote the use of e-learning for rural health workers and rural people. Acknowledgment: This work was financially supported by the Swedish International Development Agency, SIDA. References [1] Chandrasekhar, C.P. and Ghosh, J. Information and communication Technologies and health in low income countries: the potential and the constraints. Bull World Health Org 79(9): , 2001 [2] Mridha M. and Pehrson Björn, To develop a telemedicine system to improve remote diagnoses and to deliver cost effective, better quality specialist services in developing countries, International conference on Wide Open Access, 2004, Stockholm, Sweden. 5

6 A cross-sectional pilot study assessing needs and attitudes to implementation of Information and Communication Technology for rational use of medicines among healthcare staff in rural Tanzania 2B3 Jessica Nilseng, Lars L Gustafsson, Amos Nungu, Pia Bastholm-Rahmner, Dennis Mazali, Björn Pehrson, Jaran Eriksen In resource-poor countries access to essential medicines, and suboptimal prescribing and use of medicines are major public health problems. Health workers lack updated medical information and treatment support. Information and Communication Technology (ICT) could help tackle this. The impact of ICT on health systems in resource-poor countries is likely to be significant and transform the practice of medicine just as in high-income countries. However, research for finding the best way of doing this is needed. We assessed current approaches to and use of ICT among health workers in two rural districts of Tanzania in relation to the current drug distribution practices, as well as assessing the feasibility of using ICT to improve ordering and use of medicines. This pilot study was conducted in , mapping the drug distribution chain in Tanzania, including its problems and barriers. The study was conducted in Bunda and Serengeti districts, both part of a nationally supported ICT for rural development project. Health workers involved in drug procurement and use at 13 health facilities were interviewed on use of and knowledge about ICT, and their attitudes to its use in their daily work. They were also showed a potential ICT tool. This tool was a prototype application for android tables developed at the KTH Royal Institute of Technology in Stockholm. It consisted of two parts; inventory of drug stock and drug ordering, based on the Tanzanian Medical Stores Department (MSD) current paper forms. Interviewees reported stable drug supply as their main challenge: Drug supplies were often delayed and incomplete, resulting in stock-outs of essential medicines and equipment. The 20 interviewed health workers all used mobile phones, 8 of them Smartphones that they connected to the Internet. All were very positive to the drug tracking application, and expressed a great need and wish for continuous medical education by distance. New ways to order and distribute drugs, and support their use with updated knowledge are increasingly needed as soaring medicine costs and chronic diseases add to the burden on health systems. This makes it important to test and evaluate how simple ICT-technology integrated into the health-care system can improve the quality of drug ordering, distribution and use in rural parts of Africa. Studying this in a systematic way is pertinent, e.g. using the Technology Acceptance Model (TAM)

7 2B4 Exploring the potential of mobile phone and web based technology to promote the Sexual & Reproductive Health of high school aged youths in Zimbabwe Comfort Sithole 1, Leif Sandsjö 2, Bengt Arne Sjöqvist 3 1 M.Sc. Chalmers Univ. Of Technology. 2 Assist. Prof. Medtech West/School of Engineering, University of Borås. 3 Prof. of Practice, Dept. of Signals & Systems, Chalmers Univ. Of Technology 1. Introduction and Background Telemedicine or ehealth by definition encompasses the communication of health practices via technology, and the advent of the internet and mobile phone technology brought seemingly endless possibilities for telemedicine. Such technologies may be instrumental to promote health in hard to engage groups, especially young people, as interventions that make use of the internet tend to influence young people as they frequently use the internet to find information pertaining to their health. Generally, youths are put off by more traditional means of engaging with health care services, and this applies more so to accessing Sexual and Reproductive Health (SRH) services. The general consensus is that most youths appreciate the anonymity, confidentiality and convenience factors associated with accessing SRH information from the internet. 2. Aim, Method and Results This work, undertaken as a Master Thesis, is aimed at systematically exploring the potential that is offered by mobile phone technology in promoting the Sexual & Reproductive Health of high school aged youths in Zimbabwe. Youth SRH services are sparsely available in Zimbabwe and the exploitation of available and future technologies in youth SRH services has not been widely explored. The use of mobile phones in Zimbabwe is on the rise and broadband internet is becoming widely available, thus this technology can be utilized efficiently to offer services that are aimed at accurately informing the young people of Zimbabwe about their sexual and reproductive health. From the research carried out, only 10% of youths had accessed available SRH services, but given that 97% and 86% of survey participants have access to a mobile phone and the internet respectively, it would suggest that employing an SRH intervention that exploits this readily available media would be more effective. Taking into account perspective user requirements and the technological environment in Zimbabwe, the Youth Sex Health Online (YSHO) web-based SRH clinic and the complimentary Just Ask! Text messaging services were designed. YSHO is aimed at being a non-commercial one-stop shop for all adolescent SRH needs that meets identified needs in a relevant, efficient and effective manner. 3. Conclusion Feedback on the mock-up of proposed services suggests that the proposed service is effective and of particular benefit to its intended users. This work has shown that ehealth applications offer solutions to existing needs. The need for a relevant and effective youth SRH service was identified in Zimbabwe, with so many teens seemingly unsure about where to access vital information about their SRH needs. By making use of web-based and mobile phone technology that is readily available to these youths, YSHO as an ehealth application offers a solution to the need. Even though the state of ehealth in Zimbabwe is in its infancy stage, it can be suggested that investing in a national ehealth strategy and solutions like YSHO would invariably lead to a decrease in state spending in addressing some health issues. Keywords: Sexual & Reproductive Health, technology in youth SRH services, ehealth in developing countries, web-based clinic, text messaging service, mobile phone application. 7

8 2B5 M-Health Application Product Development for Physiological Disorders Based on Interaction Design Helen Sørheim 1, B.Sc., Ankica Babic 1,2, Ph.D. 1. Institute for Information and Media Science, University of Bergen, Norway 2. Department of Biomedical Engineering, Linkoping University, Sweden Introduction: The paper identifies a multidisciplinary nature of the team work needed to put in place to reassure project, design and product development that could meet needs of patients and health care givers and sustain upgrades and future development. The project is focused on patients with severe conditions such as schizophrenia in which constant monitoring and support is central to the patient well-being. There are two aspects that the development should follow: self-monitoring in stabile periods and instant help in cases of crises. Background: System development is strongly based on interaction design using input of all stakeholders (patients, patient groups, care givers, health and patient networks). It takes into account existing healthcare tools (treatment and crisis plan) and well-established treatment approaches which help utilizing good clinical resources known to all involved stakeholders. Methods & Expected Results: The Figure 1 presents the product development phases that were used as one of the development tools besides scientific and clinical ones. Figure 1 includes key activities, resources, partners and values, customer relationships and segments, channels, cost structure and revenue streams, which is identified by Osterwalder, Pigneur and Tucci (2005). Figure 1: Application business model Discussion: We have studied the business perspective of the application to sustain the product life in a demanding clinical reality. We have identified the strength of having multiple stakeholders involved from the very beginning and made the user input central to the application product development. Literature: Osterwalder, A., Pigneur, Y., & Tucci, C. L Clarifying business models: Origins, present and future of the concept. Communications of the Association for Information Science (CAIS), 16:

9 2B6 IT-baserad hemvård av djur med hjärtfel Clarence Kvart 1, Anna Gund 2, Andreas Wahl 3 1 SLU, Uppsala, Sweden. 2 Chalmers Göteborg, Sweden, 3 Karlstads djursjukhus, Sweden 1. Introduktion Studiens målsättning var att utvärdera om ett internetbaserat system benämt Petheart utvecklat från Care at Distance (Gund 2008,2011) kunde användas för att förbättra vården av hjärtsjuka hundar och katter. Detta med huvudsyfte att på ett tidigare stadium kunna upptäcka en hälsoförsämring samt visa om eftersträvad effekt uppnås vid behandling och medicinering av hjärtsvikt. 2. Metod Systemet som används i studien är internetbaserat och består av en webportal som kan nås från datorer och även nyare mobiltelefoner som har tillgång till internet. Genom att logga in på webbportalen med sitt användarnamn och lösenord kan djurägarna föra in sitt djurs mätvärden angående puls och andningsfrekvens samt svara på hälsorelaterade frågor. Väl inloggade på webbportalen kan både djurägare och vårdgivare i en spalt till vänster välja att klicka sig vidare till ett flertal olika sidor. Djurägarna kan här välja fliken Lägg in ditt djurs data för att föra in resultat från mätningar men också besvara frågor samt fliken Dialog för att kontakta vårdgivaren om de har några frågor gällande systemet eller sitt djurs hälsa. Här finns även ett hjälpavsnitt där djurägarna i text och bilder instrueras hur de på enklaste sätt utför mätningarna hemma. Fliken Dialog kan även nyttjas av vårdgivaren för att kontakta djurägaren om systemet indikerar en försämring av djurets hälsa. Inlagd data skickas över internet till en databas där den lagras. Väl lagrad kan vårdpersonal och även djurägare när som helst genom att logga in på webbportalen få tillgång till informationen. I studien ingick totalt 26 patienter, varav 17 hjärtsjuka och 9 friska individer. Samtliga djurägare hade deklarerat att de ville delta i studien och mottagit information om dess utformning. Bild 1. Exempelbild av grafer över valda fysiologiska parametrar. Andnings- och hjärtfrekvens är uppmätt och visas per 20 sekunder. Genom att markera en viss punkt på grafen erhålls inrapporterade värden aktuell dag i rutan till höger i bilden 3. Resultat och diskussion PetHearts höga acceptans och användande bland djurägarna i studien i kombination med möjligheterna till bättre hälsoövervakning och kommunikation indikerar att det skulle kunna vara ett bra komplement vid vård av hjärtsjuka hundar och katter.petheart bidrar till att en hälsoförsämring hos hjärtsjuka katter och hundar kan upptäckas i ett tidigare skede, vilket bidrar till en ökad livskvalitet, bl.a. genom att behov av att initiera eller justera medicinering kan upptäckas tidigt. Andningsfrekvensen är den bästa enskilda parametern för att upptäcka hjärtsvikt. PetHeart skapade en ökad trygghet bland djurägare till hjärtsjuka hundar och katter. En synnerligen intressant användning av systemet var att djurägare fick rapportera sitt djurs data dagligen vid ändring av hjärtmedicinering för att kunna kontrollera effekt på hälsotillståndet på distans. Speciellt användbart är detta vid utsättning av en medicinering som bedöms att sannolikt vara onödig eller insatt på felaktiga grunder. Med hjälp av det beskrivna systemet kan man lättare, även i poliklinisk verksamhet, våga sätta ut pågående medicineringar. Detta då en god kontroll av responsen kan erhållas på distans. Ett Care at Distance system, som det ovan beskrivna, kan ge ökat kurage hos veterinärer och läkare att våga sätta ut medicineringar som ej gör någon nytta men kanske försämrar patientens hälsotillstånd och livslängd. Det beskrivna systemet skulle kunna göra stor samhällsnytta om det utvecklades och kom till utbredd användning. References [1] Gund, A. (2011) On the Design and Evaluation of an ehealth System for Management of Patients in Out-of-Hospital Care. Diss. Göteborg: Chalmers Tekniska Högskola. [2] Gund, A. (2008) Design of an Internet-Based Disease Management System for Chronic Heart Failure. Akad.lic. avh. Göteborg: Chalmers Tekniska Högskola 9

10 Sammanfattningar Diagnos och behandling Session 4B Moderator: 10 10

11 4B1 CEREBRAL BIOIMPEDANCE SPECTROSCOPY: STEPS TOWARDS STROKE DETECTION Seyed Reza Atefi 1, Fernando Seoane 1,2, Kaj Lindecrantz 1,3 1 KTH Royal Institute of Technology,Huddinge, Sweden, 2 University of Borås, Borås, Sweden. 3 Karolinska institutet, Stockholm, Sweden 3 1. Introduction Following cancer and cardio-vascular disease stroke is considered as the third cause of death world-wide [1]. Considering the limitations of the most widely used diagnostic technologies for stroke detection, in particular imaging modalities, the need for portable non-invasive and less expensive diagnosis technologies that will fill the gap between current clinical routines and patient needs leading to faster and better treatment outcome is crucial. Earlier studies have demonstrated that electrical bioimpedance spectroscopy (EBIs) measurements from the cerebral tissue contain useful clinical information related to changes imposed to the cerebral tissue after the onset of the stroke [2] making EBIS a suitable candidate for this purpose. 2. Method 720 EBI measurements were collected from two different volumes ( Mc Central and larger, ML lateral and smaller) of 18 hemispheres of 9 subjects, three of whom suffering from unilateral stroke. These measurements were fitted into the Cole function consisting of four parameters R0, resistance at DC, R, resistance at frequency infinity, α and fc i.e. the characteristic frequency.. Based on Cole parameters, structural and intrinsic frequency dependent properties of the cerebral tissue reported to be altered after the onset of stroke a number of features are extracted [3], see table 1. Later on these features are fed into a tree classifier to evaluate the possibility of stroke detection based on these features. Table 1 Features Feature1 Feature2 Feature 3 ( ) ( ) 3. Results Final results with high degree of accuracy shows that after three hierarchical classification steps using the tree classifier a full classification of healthy and damaged cerebral tissue is achieved. Feature 2 Feature 3 Feature 1 Figure 1 Classification tree, at each node a threshold based on the features is applied and results are in leaves of the tree 4. Conclusion Using three features originated from the spectral information and geometry dependency of electrical bioimpedance data based on Cole parameters and a simple classification tree, an accurate classification between healthy brain hemispheres and stroke damaged ones has been performed. Despite the small size of the database available these results are sufficient to show that bioimpedance spectroscopy contains useful information to asses on stroke brain damage. References [1] G. A. Donnan, M. Fisher, M. Macleod, and S. M. Davis, "Stroke," Lancet, vol. 371, pp , May [2] G. Bonmassar, S. Iwaki, G. Goldmakher, L. M. Angelone, J. W. Belliveau, and M. H. Lev, "On the Measurement of Electrical Impedance Spectroscopy (EIS) of the Human Head," Int J Bioelectromagn, vol. 12, pp , Jan [3] S. R. Atefi, F. Seoane, and K. Lindecrantz, "Electrical Bioimpedance cerebral monitoring. Preliminary results from measurements on stroke patients," in Engineering in Medicine and Biology Society (EMBC), 2012 Annual International Conference of the IEEE, 2012, pp

12 4B2 TOWARDS AMBULANCE BASED STROKE DIAGNOSTICS Mikael Persson 1,4, Andreas Fhager 1,4, Hana Dobsicek Tréfna 1,4, Yinan Yu 1, Tomas McKelvey 1, Göran Pegenius 2, Jan-Erik Karlsson 3, Mikael Elam 2,3,4 1 Signal Processing and Biomedical Engineering, Dept. of Signals and Systems, Chalmers University of Technology, Göteborg, Sweden 2 Inst of Neuroscience and Physiology, Dept. of Clinical Neurophysiology, Sahlgrenska Academy, Göteborg University, Sweden 3 Neuro-division, Sahlgrenska University Hospital, Göteborg, Sweden 4 MedTech West, Göteborg, Sweden 1. Introduktion Around 15 million people suffer a stroke each year. The global cost of stroke is hard to assess but the total European cost has been estimated to 64.1 billion per year. The human cost of stroke is horrific with 5 million deaths/year and another 5 million are permanently disabled. Most stroke patients are not receiving optimal treatment. The majority of these are Ischemic stroke patients and should ideally receive acute thrombolytic treatment, dramatically reducing or abolishing symptoms. Today, less than 5% of these patients reach diagnosis and treatment in time, mainly due to long lead times in transport to and from the diagnostic instruments. Such treatment must be initiated within 4.5h after stroke onset, preceded by safe differentiation of haemorrhagic vs. ischemic stroke since thrombolysis can severely aggravate a haemorrhagic condition. Today this requires brain scans, calling for hospitalization before treatment. In a close collaboration between biomedical engineering, signal processing and medical scientists we have developed a system for screening patients for the presence, location and size of an intracranial haemorrhage with the ambition to create a device that could be used upon arrival in the emergency room, or by ambulance personnel at the scene of incident. 2. Methods The technology developed is a result of a long-term project dealing with microwave propagation in human tissues. The simplicity and size of a microwave-based diagnostic system underlined the possibility of creating an ambulance-based pre-hospital diagnostic system for stroke patients. The system, shown in the picture to the right, further has the advantage of being completely safe and without side effects since the power levels used are only a fraction of what is transmitted by a mobile phone. The stroke detection system consisted of antennas sending and receiving microwave signals, mounted on a helmet-like supporting structure. In order to provide a comfortable fit of the system, patch antennas with a flat surface facing the skull were used. These antennas had a rectangular shape with the radiating metallic structure of the antennas in the form of isosceles triangle with a height of 37 mm and a width of 25 mm, printed on the surface facing the skull. A total of 12 antennas were used and distributed uniformly over the surface of the skull to ensure good coverage of the brain. To accommodate varying skull sizes shapes of the patients, containers of soft plastic were placed between skull and antennas and filled with water to fill the gap. The use of the plastic containers ensured a good electromagnetic coupling between the antennas and the skull. In the measurement procedure each antenna is consecutively used as a transmitter, with all remaining antennas in receive mode. In total 66 independent transmit-receive channels were measured over a large band of frequencies, GHz. The classification algorithm is derived by using a labelled set of training data with purpose of delivering estimates of specific subspaces for each of the two classes. The estimated subspaces are the reduced by removing a number of dimensions for each subspace in order to increase the smallest principal angle between the subspaces. The classification algorithm projects the measurement data vector onto both the subspaces and selects the predicted class label based on which of the projections results in the longest vector. The accuracy of the classifier is evaluated on the clinical data by combining the leave-one-out cross validation method with a bootstrap sampling technique to reduce the variance of the performance estimates. 3. Results We have performed a clinical study using the above described brain diagnostic devices based on microwave technology. With the detector aimed at identifying all 10 patients with haemorrhagic stroke, 13 out of 15 ischemic stroke patients were clearly separated from haemorrhagic stroke patients whereas 2 were not. The results show that this type of device and the associated algorithms can differentiate haemorrhagic from ischemic stroke patients. In summary we have reported on a new system and a clinical studies that set the stage for pre-hospital diagnosis and treatment in ambulances for the 15 million yearly stroke patients around the world thus helping society to meat one of the major unmet challenges of the global health care system

13 4B3 ASSESSING OBSTRUCTIVE AIRWAY DISORDERS BY MEANS OF COMPUTATIONAL FLUID DYNAMICS (CFD) Mihai Mihăescu 1, Laszlo Fuchs 1, Nelson Powell 2 1. Background and Motivation The upper respiratory tract is susceptible to obstruction like abnormalities that can be caused by various mechanisms at one or multiple locations and can affect the airway functions. Often, the interaction between the flow and the obstruction involves dynamic changes in the flow regime, flow recirculation regions, flow induced instabilities, nonlinear pressure drop/flow rate relations, self excited oscillations of the soft tissue, and flow induced noise. It is believed that the changes in the flow patterns associated with an obstruction are playing an important role for the progress of the disorder over the time. Obstructive Sleep Apnea (OSA) is the most common obstructive airway disorder, affecting more than 12 million people in US alone. It is characterized by partial or complete narrowing of the pharyngeal airway during sleep (hypopneas and apneas), resulting in partial or complete airflow cessation and Oxygen de saturation. Overnight Polysomnography is considered the gold standard for its diagnosis. It is an expensive and time consuming process for both patient and evaluator. The OSA severity is expressed using Apnea Hypopnea Index (AHI), which represents the total number of hypopneas and apneas occurring in one hour of sleep. A mild OSA is indicated by an AHI between 5 and 15, while severe conditions are those for which AHI is greater than 30. Medical imaging techniques (e.g. Computed Tomography, Magnetic Resonance Imaging) facilitated anatomical measurement of the airway, but they have little clinical utility for quantifying the functional impact of an airway obstruction. These techniques cannot offer details about the effect of the airway s anatomical features on the airflow or on airway resistance to assess obstruction s severity. 2. Methodology An upper respiratory tract simulator based on medical imaging for extracting patient specific upper respiratory tract anatomy and Computational Fluid Dynamics (CFD) for computing the airflow through the pharyngeal airway are employed [1]. CFD is able to predict fluid flow characteristics by solving the physical laws of fluid mechanics (Navier Stokes equations) using numerical methods and algorithms embodied in the form of a computer code. The tool is proposed as a non intrusive and inexpensive diagnosis technique for obstructive airway disorders. Thus, not only the specific anatomic measurements are acquired (i.e. pharyngeal airway dimensions, cross sectional area, and volume) but also pertinent data to the airflow are computed (e.g. airway resistance, flow patterns, velocity, pressure, turbulence production, or wall shear stresses). The data obtained in normal healthy pharyngeal respiratory tracts (Controls) are averaged and used to generate a Baseline against which the results obtained in sleep disordered breathing patients at pre and post treatment are compared and contrasted. 3. Results Clinical and CFD based data concerning four healthy adult subjects and four OSA patients at pre and post treatment conditions are presented in the Figure 1. The medical imaging and the AHI data were obtained at the Sleep and Research Center, Stanford University. Despite of the low number of subjects considered, a strong correlation is observed between the CFD data (mean pharyngeal airway resistance) and the clinically obtained AHI values. A correlation coefficient of was calculated. About an order of magnitude difference between the pre (red) and the post treatment resistances (green) is found. The post treatment airway resistances are bellow or in the range of the averaged airway resistance estimated for the healthy subjects (blue). The proposed approach allows thus differentiating between healthy subjects and individuals with OSA. Figure 1: Predicted airway resistance and clinically measured AHI plotted for four Controls and four OSA patients at pre and post treatment conditions. 4. Discussion The present study represents an important step in building a tool for quantifying OSA and for assessing treatment outcome. Such a computational model shall enable to determine and understand the patho physiology of the sleep disorder and the risks for airway collapse and flow induced obstruction at pre and post treatment conditions. The simulation of the pharyngeal airflow may allow the surgeon to add quantitative data into his/her decision making, which is often based on semi quantitative or qualitative clinical findings. Acknowledgments The work is supported by the Swedish Research Council (VR ). Also, the financial support from the Göran Gustafsson Stiftelse by means of The Göran Gustafsson Young Scientist Award (UU/KTH) conferred to Dr. Mihaescu is greatly acknowledged. References [1] M. Mihăescu, G. Mylavarapu, E. Gutmark, and N. Powell, Large Eddy Simulation of the pharyngeal airflow associated with Obstructive Sleep Apnea Syndrome at pre and post surgical treatment., 44, , (2011). 13

14 4B4 DEVELOPING A WEARABLE MICROWAVE INSTRUMENT FOR DETECTING THORAX INJURIES TESTS ON A PNEUMOTHORAX PHANTOM Stefan Candefjord 1 3, Prateek Saraswat 1, Robert Samo 1, Tomas McKelvey 1, 2, Andreas Fhager 1, 2, Mikael Persson 1, 2 1 Chalmers tekniska högskola, Göteborg, Sweden 2 MedTech West, Göteborg, Sweden 3 SAFER Vehicle and Traffic Safety Centre at Chalmers 1. Introduction Traumatic injuries is the leading cause of death for young people. A quarter of these deaths are a consequence of thorax injuries [1]. Pneumothorax (PTX) is a collection of air in the thoracic cavity caused by a rupture in the membranes surrounding the lung. Failure to diagnose and swiftly treat a PTX that is enlarging may cause patient death [1]. There is a need for an instrument to be used in the prehospital setting for objective detection of PTX. 2. Materials and Methods A wearable microwave instrument with six antennas was constructed using a leather belt and in-house fabricated patch antennas; measurements were performed on healthy volunteers (Figure 1). A simplified model of the human thorax was constructed using plastic containers of suitable sizes, filled with an appropriate mixture of ethanol and deionized water to obtain realistic dielectric properties; a container in the shape of an elliptical frustum (inner volume 12 L, with the smaller ellipse as the base) represented the thoracic cavity, and two cylindrical containers (inner volume 2 L) formed the lung space (Figure 1). To simulate a PTX, the lung space was left empty and a plastic bag resembling a collapsed lung filled with a dielectrically suitable liquid was placed inside. Measurements were performed for PTX sizes of 10%, 20% and 50% in the left or the right lung; sixty measurements were randomly drawn from this dataset and represented the PTX observations. An additional sixty measurements were performed on a phantom without PTX. The belt was repositioned after every third measurement. Measurements were conducted in a random order. A classification algorithm based on finding the minimum distance to the subspace bases, which were calculated by singular value decomposition of the training data matrix, was used to distinguish between the measurements of No PTX and PTX. The leave-one-out approach was used, i.e. the sample to be classified was not included in the training data matrix, in order to not overestimate the classification performance. 3. Results & Discussion Measurements of the human thorax and the thorax model showed similar characteristics. The classification algorithm differentiated PTX and No PTX (Figure 2). All No PTX and all except two PTX observations were correctly classified. This is an encouraging result for pursuing the development of an instrument for PTX detection in the prehospital setting. References [1] A. Sharma and P. Jindal, Journal of Emergencies, Trauma, and Shock, 71, (2008). Figure 1: Left: The wearable microwave device (earlier version with four antennas). Right: Top view of the human thorax model, antenna locations are labelled A1 A6. Subspace distance [ ] 2 1 No PTX 0 0 d No PTX d PTX d No PTX d PTX Figure 2: Box plots showing the distance to each subspace basis for the two classes, i.e. No PTX or PTX. The line in the middle of the box shows the median, and the bottom and the top of the box show the 25th and 75th percentile, respectively. Subspace distance [ ] PTX 14 14

15 4B5 A compact wideband antenna for microwave hyperthermia system Pegah Takook 1, Hana Dobsicek Trefna 2, Mikael Persson 3 1 Chalmers university of technology, Göteborg, Sweden. 2 Chalmers university of technology, Göteborg, Sweden. 3 Chalmers university of technology, Göteborg, Sweden 1. Introduction Hyperthermia treatment is a medical treatment during which the temperature is raised in tumours for a sufficient period of time, to kill the cancer cells or make them more sensitive to ionizing radiation or chemotherapy. Different type of antennas have been used so far in deep hyperthermia applicators, such as water-filled waveguide antennas, dipole antennas or probe-fed patch antennas. These antennas are either large and heavy (like as the waveguide antennas) or present very narrow bandwidth which are not desired characteristics. In this paper we present a compact, wideband antenna to be used in hyperthermia antenna applicator. This applicator is developed for microwave hyperthermia of deep seated tumours in head and neck. The antenna should be of small size, with wide frequency band and directive radiation pattern. The desired wide bandwidth of 0.4 to 0.9 GHz, is due to multiple frequency approach in our treatment strategy. 2. Method The antenna consists of two parts: the self-grounded Bow-tie antenna and the balun. The Bow-tie antenna covered, by teflon from the upper-side, is completely immersed in water. The Teflon improves the antenna's reflection coefficients and high permittivity of the water leads to a significantly reduced size antenna. To transform the 30-ohm-impedance feed-line of Bow-tie in the background of water to a 50-ohm-impedance microstrip line, a wideband balun has been designed. Finally the shape and size of the water bolus is quantified by 50% iso-sar contours as indicators of penetration depth and the directivity. 3. Results Our designed wideband balun presents a return loss of better than 10 db and the transmission coefficient about -0.5 db over a bandwidth from 0-1 GHz. Also the simulations results of the antenna shows the best performance in terms of the S11 for the bow-tie of size 18*27*7 mm 3 and conical shape water bolus of size 40*80*30 mm 3 (diameters of the upper and lower circular bases and height). The obtained reflection coefficients are below -10 db over most of the desired bandwidth, and below -5 db for less than 0.45 GHz and higher than 0.85 GHz. Figure 1: Simulated bow-tie antenna in water bolus with the designed balun 4. Discussion and conclusion The presented self-grounded bow-tie antenna with added teflon, immersed in water-filled conical shape bolus and with the designed wideband balun, presents a wideband performance over the desired frequency range of GHz. References [1] H.D. Trefna, J.F. Bakker, J. Vrba, Mikael. Persson. ''Evaluation of a patch antenna applicator for time reversal hyperthermia.''international Journal of Hyperthermia, March [2] M.M. Paulides, J.F. Bakker, N. Chavannes, G.C. Van Rhoon. ''A patch antenna designed for application in a phased-array head and neck hyperthermia applicator.'' IEEE Trans. Biom. Eng. 15

16 4B6 APPLICATOR FÖR MIKROVÅGSBASERAD BEHANDLING AV HUVUD- OCH HALSTUMÖRER Hana Dobšíěek Trefná 1, Pegah Takook 1, Johanna Gellermann 2, Mikael Persson 1 1 Chalmers University of Technology, Sweden. 2 University Hospital Tubingen 1. Introduction Hyperthermia is presently used as an adjuvant to the radiation therapy in the treatment of certain types of cancers. Recently, randomised trials have shown a significant advantage of combining hyperthermia with radiotherapy and/or chemotherapy in the treatment of solid tumours [1,2]. The objective of hyperthermia treatment is to raise the temperature in the tumour to a therapeutic level C for a sufficient period of time to achieve cell death or render the cells more sensitive to ionizing radiation and chemical toxins. In this contribution, we present a novel design of an antenna applicator for hyperthermia treatment in Head & Neck region. 2. Method The applicator consists of 12 to 18 elements arranged in one to three ring set-ups. The distance between the rings is 30 mm. The self-grounded Bow-Tie immersed in conical water bolus serves as an applicator element,. The operating frequency range is from 400 to 1000 MHz. In order to keep distance in terms of wavelength between radiating elements body at different frequencies, the diameter of the applicator is adjustable and varies between 340 and 460 mm. In order to cool down the body surface, an additional water layer is placed between the body and water boli of the antennas. This layer has thickness of 1-2 cm and contain circulating cold water. 3. Results The focusing abilities of the applicator are evaluated by using a numerical model of an anthropomorgical phantom of H&N region. The phantom, containing small laryngeal tumor of volume approx. 15 mm 3 consists of 6 tissues. The treatment plans were calculated by using the time reversal algorithm [3]. The results show a considerable heating in terms of SAR in the target region with a remarkably low heating in critical tissues (i.e. spinal column). The obtained SAR distribution is favorable, although a relatively high level of energy is also absorbed on the surface of the body. It is apparent that this heating is local and not expected to cause problems as it can be cooled by blood perfusion and water bolus. The obtained results also justify advantages of using the multi-frequency approach in treatment planning. 4. Conclusions The results presented in this study are promising, awaiting the experimental evaluation on the physical version of the phantom. References [1] J. Van der Zee, D. Gonzáles Gonzáles, et al., Comparison of radiotherapy alone with radiotherapy plus hyperthermia in locally advanced pelvic tumours: a prospective, randomised, multicentre trial, Lancet, vol. 355, pp , [2] R.D. Issels, L.H. Lindner, J. Verweil, et al., Neo-adjuvant chemotherapy alone or with regional hyperthermia for localised high-risk softtissue sarcoma: a randomised phase 3 multicentre study., Lancet Oncol., Vol.11(6), pp , [3] H. Dobšíček Trefná, J. Vrba, and M. Persson, Time-Reversal Focusing in Microwave Hyperthermia for Deep-Seated Tumours, Phys Med Biol, vol 55, pp , Figure 1: Applicator design and SAR distribution in phantom containing laryngeal tumor

17 Sammanfattningar Ehälsa/IKT II Session 2C Moderator: Bengt Arne Sjöqvist 17 17

18 2C1 itacih - it-stöd för Avancerad Cancervård i Hemmet Jimmy Johansson 1, Boris Magnusson 2, Rickard Fredin 3, Hlin Thorgeirsson 4 1 Medicinsk teknik, Skånes universitetssjukhus, Lund/Malmö, Sweden. 2 Datavetenskap, Lunds Tekniska Högskola, Lund, Sweden. 3,4 Palliativa enheten, Primärvården Skåne, Lund, Sweden. Inledning Ett integrerat it-stöd för avancerad cancervård i hemmet är nu i klinisk drift inom den palliativa enheten i Lund. Den mobila vårdpersonalen har en mobil enhet med uppdaterad information för respektive patient de ska besöka samt stöd för dokumentering. Den mobila enheten utbyter kontinuerligt information med en avdelningsenhet som är placerad på verksamhetens expedition. På så sätt kan den rondande vårdpersonalen få en uppdaterad bild av patienternas status. Den mer avancerade medicintekniska utrustningen i form av provtagningsutrustning, infusionspumpar och monitoreringsutrustning är också uppkopplad mot systemet och tekniken utvärderas i en simulerad hemmiljö, tillsammans med patienter inom den palliativa slutenvårdavdelningen. På så sätt kan vi ta med oss feedback i vidareutvecklingen och bemöta de krav som ställs för att på ett säkert sätt integrera denna typ av utrustning i hemmet. Vi lägger stor vikt vid användbarhet och har experter i projektet som fortlöpande utvärderar detta. Bakgrund Projektet, it-stöd för Avancerad Cancervård i Hemmet (itacih), syftar till att upprätta en avancerad vårdplats i hemmiljö med inriktning mot cancervård. Antalet cancerfall beräknas öka, även oberoende av den ökande andelen äldre i befolkningen. En av tre svenskar drabbas av cancer och med allt bättre möjligheter till behandling lever allt fler längre med sin sjukdom vilket innebär ökade krav på avancerad sjukvård i livets slutskede. För att det ska vara möjligt att ge kvalitativ vård med den ökande belastningen på samhället som detta innebär måste det finnas nya vägar för omvårdnad både under aktiv behandling och i livets slutskede. Ny teknik kommer att öka antalet patienter som kan ges möjlighet att vårdas hemma, vilket en stor del av dagens patienter önskar. Det huvudsakliga målet för projektet är att göra det möjligt för fler patienter med cancer att vårdas hemma. Detta förutsätter att det kännas lika tryggt att vara hemma som på en vårdavdelning. Genom att utveckla tekniker för övervakning av utrustning som finns runt patienten, i vissa fall fjärrstyrning av utrustningen, kombinerat med kommunikation mellan hem och vårdpersonal, såväl vårdavdelning som mobila vårdteam, hoppas vi kunna åstadkomma en sådan situation. Projektet finansieras genom VINNOVA:s program för utmaningsdriven innovation som riktar sig till breda sektors- och ämnesöverskridande konstellationer som gemensamt vill arbeta för att möta samhällets utmaningar. Konstellationen består av företag från olika sektorer, tvärdisciplinär forskning från universitet, forskningsinstitut, offentlig sektor och ideella organisationer enligt bilden nedan. Projektet, itacih, har en budget på 22 miljoner, varav 10 miljoner från VINNOVA och 12 miljoner i form av medfinansiering från partners, och en tidsplan som sträcker sig över 2012 och Utveckling I detta tvärvetenskapliga projekt samverkar datatekniker, medicintekniker, sjukvårdspersonal och företag från olika discipliner för att tillsammans lösa detta komplexa problem. Projektet drivs efter en iterativ modell där två delprojekt, utveckling och kravställning, fortgår parallellt. Processer för utveckling, riskhantering och användbarhet etablerats för att hantera de regulatoriska kraven för medicintekniska produkter. Fram till nu har fokus legat på att etablera en underliggande infrastuktur samt tillhandahålla ett integrerat it-stöd för vårdpersonalen. Nästa steg blir att även integrera enheter som stödjer patienter och anhöriga. Vi har genom samarbetet med Nätverket mot cancer genomfört workshops tillsammans med patienter och anhöriga för att designa ett system som utgår från de viktigaste behoven och för att ta hänsyn till de integritetsaspekterna man tidigt stöter på. Det pågår ett antal examensarbete inom ramen för projektet som syftar till att anpassa produkter som idag är avsedda för sjukhusbaserad vård och behöver anpassas vad gällande både säkerhet och mobilitet. Resultat och slutsatser Ungefär 1,5 år in i projektet ser vi att det som tas fram både är välkommet i verksamheten och med stor sannolikhet är ett måste för att avancerad sjukvård i hemmet ska kunna växa i den omfattningen som prognoserna pekar på. Utöver behovet, av ett integrerat it-stöd, som identifierats inom verksamheten för avancerad sjukvård i hemmet har ett tydligt behov identifierats i andra ambulerande verksamheter som t.ex. primärvården och kommunen. Även andra verksamheter inom sjukhusbaserad specialiserad öppenvård såsom diabetesmottagningen, hemdialysenheten och barnkliniken har visat stort intresse. Nu arbetar vi för att i första hand slutföra utvecklingen som möter den avancerade cancervården i hemmet men tittar även på möjligheten att specialanpassa systemet för barn och andra vårdområden. 18

19 2C2 A Novel Data-Mining Approach Using Social Media to Respond to Outcomes of Diabetes Treatment ALTUG R. AKAY 1, ANDREI DRAGOMIR 2 BJÖRN-ERIK ERLANDSSON 3 1 KTH Royal Institute of Technology, Huddinge, Sweden. 2 University of Houston, Houston, Texas 3 KTH Royal Institute of Technology, Huddinge Sweden. 1. Heading (eg Introduction) Social media, ranging from personal messaging to live foras, is providing limitless opportunities for patients to discuss their experiences with drugs and devices. It is also providing limitless opportunities for companies to receive feedback on their products and services [1]. Pharmaceutical companies are already looking at social network monitoring as a top priority within their IT departments, potentially creating an opportunity for rapid dissemination and feedback of products and services to optimize and enhance delivery, and reduce costs [2]. Traditional social sciences use surveys and involve subjects in the data collection process. Limited by this process, data collected is of small sizes and typically hundreds of subjects in one study. By contrast, thousands of users of social media produce inordinate amounts of data with rich user interactions. There are two simple ways to extract this information: 1) crawling using site provided APIs, or 2) scraping needed information from rendered html pages. Many social media sites provide APIs: Twitter, Facebook, YouTube, Flickr, etc. We can also follow how its properties change over time, which would greatly interest public health studies. 2. Heading (eg Method) We used text and data-mining tools in Rapidminer (www.rapidminer.com) to develop opinion labels about each drug and device (positive, negative, neutral) per node within a network, build networks from the search results of the forum, and developed a network ranking system reflecting the degree to which the respective network is involved in the opinion formation about the drug/disease. Each forum group (separated by drugs and/or devices discussed) was fed into Rapidminer and preprocessed by removing unwanted characters (HTML tags, punctuation, numbers) and common stop words (e.g. a, the, it, etc.), breaking down words into token words, stem tokens into root words (e.g. working ->work; lost, lose->los). The end result was a wordlist per vector using a binary system to identify words within a vector ( 1 = the word was present, 0 = the word was absent). 3. Results The following figure is the graphical representation of the SOM of the positive words group. We used a 10 x 10 map size with thirty variables present. Fig. 1. Positive Words The clustering resulting from the SOM analysis reveal that the positive words (along with positive words and drugs) have a larger presence in the cluster groups. Negative words (along with negative words and drugs) had a much lower presence in the cluster groups. We developed a list of words dominating the clusters. 4. Discussion The goal of this study was to transform forum posts into vectors to scan for patterns in the responses to gauge consumer opinion of the drugs and devices used to treat diabetes mellitus. The clusters belonging to the Positive and Positive + Drugs categories contained more positive words (per vector and per frequency) compared to the Negative and Negative + Drugs group. This gives the impression of an overall positive user satisfaction and experience with the specified drugs and devices. A future study will go more deeply into the interaction amongst the users to develop a more thorough web of user influence and opinion and how user influence (based on quality of posts and ranking within the forum) affects interactions with other users (replies, friendships, the timing and quality of posts in threads) [3]. Future research will expand to include other diseases such as oncology. With social media becoming an expanding venue for people to express their thoughts, ideas, and reactions, it represents a goal mine for companies seeking to optimize health delivery and reduce costs. References [1] Alberto Ochoa, Arturo Hernández, Laura Cruz, Julio Ponce, Fernando Montes, Liang Li and Lenka Janacek (2010). Artificial Societies and Social Simulation Using Ant Colony, Particle Swarm Optimization and Cultural Algorithms, New Achievements in Evolutionary Computation, Peter Korosec (Ed.), ISBN: , InTech (http://www.intechopen.com/articles/show/title/artificialsocieties-and-social-simulation-using-ant-colony-particle-swarm-optimization-and-cultural) [2] Pharma 2.0 Social Media and Pharmaceutical Sales and Marketing [3] Identifying influential users in an online healthcare social network, X. Tang, C.C Yang, ISI

20 2C3 Case Based Reasoning in Support of the LVAD Surgical Treatment Ankica Babic, PhD, Department of Biomedical Engineering, Linköping University Introduction. In approximately 1-3% of patients undergoing open-heart surgery, there is a need for Left Ventricular Assist Device (LVAD) due to heart failure when weaning from cardiopulmonary bypass (CPB) [1]. To minimize the high mortality and morbidity rates it is important to chose the right treatment for the particular patient situation. The amount of the data collected in electronic patient records might be limited for an elaborate statistical analysis, but it is very critical for assuring a timely and accurate clinical insight into a patient particular situation. Case Based Reasoning (CBR) methodology provides means of collecting patients cases and retrieving them following the clinical criteria [2]. By studying previously treated patients with similar backgrounds, the physician can get a better support for deciding on treatment and be better prepared for complications that might occur during and after surgery. Case Based Reasoning (CBR) engine was developed using an extended version of the Nearest Neighbor'a algorithm, which uses logarithms that emphasize small differences between similar cases. A patient case (Figure 1) is represented as a combination of perioperative variable values and operation reports. Physicians could review a selected number of cases by browsing through the electronic patient records and operational narratives which provides an exhaustive insight into the previously treated cases. Figure 1. A Patient Case. Results. An evaluation of the search algorithm suggests good functionality: an experienced physician retrieves cases using fewer clinical variables while the novice selects more variables which influences the distance calculation and consequently the set of the K nearest cases. The CBR engine had been implemented as a part of a web-based decision support system for thoracic surgery. Literature. 1. B Peterzén, U Lönn, A Babic, H Granfeldt, H Casimir-Ahn, H Rutberg. Postoperative Management of Patients With Hemopump Support After Coronary Artery Bypass Grafting. Ann. Thorac. Surg. 1996;62: Holt A et al., The Knowledge Engineering Review / Volume 20 / Issue 03 / September 2005, pp

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