Research Article
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Kronik Hastaların Uzaktan İzlemine Yönelik Teletıp Platformu

Year 2020, Volume: 22 Issue: 64, 37 - 46, 24.01.2020
https://doi.org/10.21205/deufmd.2020226405

Abstract









Kronik hastalıklar küresel bazda
artış göstermekte olup ancak etkili bir hastalık yönetimiyle kontrol altına
alınabilmektedirler. Bu hastalıkların kontrolü için hastaların uzaktan
izlenmesine olanak sağlayan teletıp sistemlerinin büyük fayda sağlama potansiyelleri
vardır. Ancak bu sistemlerin ölçeklenebilirliğini ve sürdürebilirliğini
sağlamak önem arz etmektedir. Bu çalışmada, kronik hastaların uzaktan takibini
gerçekleştirebilmek için yeni bir teletıp platformu önerilmektedir. Bu platform
hastalara sağlık verilerini sistem üstünden doğrudan ve kolaylıkla takiplerini
yapan sağlık personeli ile paylaşabilme olanağı sunmaktadır. Sağlık personeli
ise hastalık seyrindeki gelişmeleri ve tedavi hedeflerini bu veriler sayesinde
uzaktan kontrol edebilmektedir. Ayrıca sağlık personeli platform üzerinden
belirleyeceği hastaya özel sağlık verisi eşik değerleri ile kendisine ve/veya
hastaya otomatik bildirim mesajı gönderebilmekte, böylelikle hasta verilerini
sürekli manuel olarak incelemek yerine, platform üzerinden gelecek bildirimler
vasıtasıyla hastaya gerektiği zaman ve vakit kaybetmeksizin müdahalede
bulunabilmektedirler. Önerilen platform ile kronik hastalık yönetimi
iyileştirilebileceği gibi sağlık personeline olabildiğince az iş yükü
getirilerek verilecek sağlık hizmetinde verim ve kalite artışının da
sağlanmasıyla platformun sürdürülebilirliği de temin edilebilecektir. Çalışmada
platformun ölçeklenebilirliği, eş zamanlı istek testleri ile analiz edilmiştir.
Platform üstünden bildirim mesajı göndermenin, 500 eş zamanlı istek için düşük
tepki süresi (~750 ms), yüksek verimlilik (saniyede ~250 istek) ve düşük hata
oranı (%1.3) ile gerçekleştiği gözlenmiştir. Bu sonuçlar tasarlanan teletıp
platformunun birçok kullanıcıdan gelen veri akışının üstesinden gelebileceğini
ve platformun ölçeklenebilir olduğunu göstermektedir.

References

  • The World Health Organization Regional Office for Africa. 2017. http://www.afro.who.int/health-topics/noncommunicable-diseases (Erişim tarihi: 17.01.2019).
  • The World Health Organization. 2018. http://www.who.int/gho/ncd/mortality_morbidity/ncd_total/en/ (Erişim tarihi: 17.01.2019).
  • Rauniyar, M., Shrestha, J., Raj, L. B., Shrestha, A., Acharya, K. 2017. Disease Pattern, Morbidity Indicators in a Tertiary Care Center of a Developing Country, Annals of Public Health and Research, Cilt. 4, s. 1055.
  • Bane, A., Bayisa, T., Adamu, F., Abdissa, S. G. 2016. Medical Admissions and Outcomes at Saint Paul’s Hospital, Addis Ababa, Ethiopia: a retrospective study, Ethiopian Journal of Health Development, Cilt. 30, s. 50-56.
  • Hernandez, C., Jansa, M., Vidal, M., Nunez, M., Bertran, M. J., Garcia-Aymerich, J., Roca, J. 2009. The burden of chronic disorders on hospital admissions prompts the need for new modalities of care: a cross-sectional analysis in a tertiary hospital, QJM, Cilt. 102, s. 193-202. DOI: 10.1093/qjmed/hcn172
  • Bloom, D.E., Ca ero, E.T., Jané-Llopis, E., Abrahams-Gessel, S., Bloom, L.R., Fathima, S., Feigl, A.B., Gaziano, T., Mowa , M., Pandya, A., Prettner, K., Rosenberg, L., Seligman, B., Stein, A.Z., Weinstein, C. 2011. The global economic burden of noncommunicable diseases, World Economic Forum, Geneva, 46s.
  • Boutayeb, A. 2006. The double burden of communicable and non-communicable diseases in developing countries, Trans R Soc Trop Med Hyg, Cilt. 100, s. 191-199. DOI: 10.1016/j.trstmh.2005.07.021
  • The World Health Organization. 2018. http://www.who.int/en/news-room/fact-sheets/detail/noncommunicable-diseases (Erişim tarihi: 17.01.2019).
  • Rietzschel, E. R., De Buyzere, M. L. 2018. Hypertension: time for doctors to switch the driver's seat?, Lancet, Cilt. 391, s. 914-916. DOI: 10.1016/S0140-6736(18)30317-9
  • Kessel, K. A., Vogel, M. M., Kessel, C., Bier, H., Biedermann, T., Friess, H., Herschbach, P., von Eisenhart-Rothe, R., Meyer, B., Kiechle, M., Keller, U., Peschel, C., Schmid, R. M., Combs, S. E. 2017. Mobile Health in Oncology: A Patient Survey About App-Assisted Cancer Care, JMIR Mhealth Uhealth, Cilt. 5, s. e81. DOI: 10.2196/mhealth.7689
  • Strehle, E. M., Shabde, N. 2006. One hundred years of telemedicine: does this new technology have a place in paediatrics?, Arch Dis Child, Cilt. 91, s. 956-959. DOI: 10.1136/adc.2006.099622
  • Sood, S., Mbarika, V., Jugoo, S., Dookhy, R., Doarn, C. R., Prakash, N., Merrell, R. C. 2007. What is telemedicine? A collection of 104 peer-reviewed perspectives and theoretical underpinnings, Telemed J E Health, Cilt. 13, s. 573-590. DOI: 10.1089/tmj.2006.0073
  • Piette, J. D., Valverde, H., Marinec, N., Jantz, R., Kamis, K., de la Vega, C. L., Woolley, T., Pinto, B. 2014. Establishing an independent mobile health program for chronic disease self-management support in bolivia, Front Public Health, Cilt. 2, s. 95. DOI: 10.3389/fpubh.2014.00095
  • Azar, M., Gabbay, R. 2009. Web-based management of diabetes through glucose uploads: Has the time come for telemedicine?, Diabetes Research and Clinical Practice, Cilt. 83, s. 9-17. DOI: 10.1016/j.diabres.2008.09.055
  • Agarwal, R., Bills, J. E., Hecht, T. J., Light, R. P. 2011. Role of home blood pressure monitoring in overcoming therapeutic inertia and improving hypertension control: a systematic review and meta-analysis, Hypertension, Cilt. 57, s. 29-38. DOI: 10.1161/HYPERTENSIONAHA.110.160911
  • McManus, R. J., vd. 2018. Efficacy of self-monitored blood pressure, with or without telemonitoring, for titration of antihypertensive medication (TASMINH4): an unmasked randomised controlled trial, Lancet, Cilt. 391, s. 949-959. DOI: 10.1016/S0140-6736(18)30309-X
  • Friedman, R. H., Kazis, L. E., Jette, A., Smith, M. B., Stollerman, J., Torgerson, J., Carey, K. 1996. A telecommunications system for monitoring and counseling patients with hypertension. Impact on medication adherence and blood pressure control, Am J Hypertens, Cilt. 9, s. 285-292. DOI: 10.1016/0895-7061(95)00353-3
  • Piette, J. D., Datwani, H., Gaudioso, S., Foster, S. M., Westphal, J., Perry, W., Rodríguez-Saldaña, J., Mendoza-Avelares, M. O., Marinec, N. 2012. Hypertension Management Using Mobile Technology and Home Blood Pressure Monitoring: Results of a Randomized Trial in Two Low/Middle-Income Countries, Telemedicine and e-Health, Cilt. 18, s. 613-620. DOI: 10.1089/tmj.2011.0271
  • Ferrante, D., Varini, S., Macchia, A., Soifer, S., Badra, R., Nul, D., Grancelli, H., Doval, H., Investigators, G. 2010. Long-term results after a telephone intervention in chronic heart failure: DIAL (Randomized Trial of Phone Intervention in Chronic Heart Failure) follow-up, J Am Coll Cardiol, Cilt. 56, s. 372-378. DOI: 10.1016/j.jacc.2010.03.049
  • Bellazzi, R., vd. 2002. A telemedicine support for diabetes management: the T-IDDM project, Comput Methods Programs Biomed, Cilt. 69, s. 147-161. DOI: 10.1016/S0169-2607(02)00038-X
  • Milani, R. V., Lavie, C. J., Bober, R. M., Milani, A. R., Ventura, H. O. 2017. Improving Hypertension Control and Patient Engagement Using Digital Tools, Am J Med, Cilt. 130, s. 14-20. DOI: 10.1016/j.amjmed.2016.07.029
  • Shoulders, B., Powell, L. 2019. Reaching for Goal: Incorporating the Latest Hypertension Guidelines Into Practice, The Journal for Nurse Practitioners, Cilt. 15, s. 102-109. DOI: 10.1016/j.nurpra.2018.09.011
  • Milani, R. V., Bober, R. M., Milani, A. R. 2017. Hypertension management in the digital era, Curr Opin Cardiol, Cilt. 32, s. 373-380. DOI: 10.1097/HCO.0000000000000405
  • Bode, B. W. 2000. Clinical utility of the continuous glucose monitoring system, Diabetes Technol Ther, Cilt. 2, s. 35-41. DOI: 10.1089/15209150050214104
  • Ndlovu, K., Littman-Quinn, R., Park, E., Dikai, Z., Kovarik, C. L. 2014. Scaling up a Mobile Telemedicine Solution in Botswana: Keys to Sustainability, Front Public Health, Cilt. 2, s. 275. DOI: 10.3389/fpubh.2014.00275
  • Fromme, H. B., Chen, C. O., Fine, B. R., Gosdin, C., Shaughnessy, E. E. 2018. Pediatric Hospitalist Workload and Sustainability in University-Based Programs: Results from a National Interview-Based Survey, J Hosp Med, Cilt. 13, s. 702-705. DOI: 10.12788/jhm.2977
  • Trent, S., Tatsubori, M., Suzumura, T., Tozawa, A., Onodera, T. 2008. Performance Comparison of PHP and JSP as Server-Side Scripting Languages, s. 164-182. Issarny, V., Schantz, R., ed. 2008. Middleware 2008, Springer, Berlin, Heidelberg, 428s. DOI: 10.1007/978-3-540-89856-6_9
  • Hu, X., Wang, L., Sheng, Z., TalebiFard, P., Zhou, L., Liu, J., Leung, V. C. M. 2014. Towards a service centric contextualized vehicular cloud. The fourth ACM international symposium on development and analysis of intelligent vehicular networks and applications, 21-26 Eylül, Montreal, Kanada, s. 73-80. DOI: 10.1145/2656346.2656351

Telemedicine Platform for Remote Monitoring of Chronic Patients

Year 2020, Volume: 22 Issue: 64, 37 - 46, 24.01.2020
https://doi.org/10.21205/deufmd.2020226405

Abstract
















Chronic
diseases are increasing globally and can only be controlled with effective
disease management. Telemedicine systems allowing remote monitoring of patients
have a potential to bring great benefit for controlling these diseases.
However, it is important to ensure the scalability and sustainability of these
systems. Here, a new telemedicine platform is presented for remote monitoring
of chronic patients. This platform provides patients to share their health data
directly and easily with the health care personnel, who can remotely control
disease progress and treatment goals with the shared data. Furthermore, the
personnel can send an automatic notification message to themselves or/and to
the patient when a patient specific health data threshold value set through the
platform is reached. Hence, the health care personnel can improve the disease
management with timely interventions using the platform notifications, instead
of analyzing the data constantly. With this platform, chronic disease
management can be enhanced and the sustainability of the platform can be
ensured by bringing as little workload as possible to the personnel while
increasing the efficiency and quality of health service. In the study, the
scalability of the platform was analyzed using concurrent request tests. It was
observed that sending the notification message through the platform was handled
with low response time (~ 750 ms), high throughput (~ 250 requests per second)
and low error rate (1.3%) for 500 concurrent requests. These results show that
the designed telemedicine platform can manage the data flow from many users and
the platform can be scalable.
    

References

  • The World Health Organization Regional Office for Africa. 2017. http://www.afro.who.int/health-topics/noncommunicable-diseases (Erişim tarihi: 17.01.2019).
  • The World Health Organization. 2018. http://www.who.int/gho/ncd/mortality_morbidity/ncd_total/en/ (Erişim tarihi: 17.01.2019).
  • Rauniyar, M., Shrestha, J., Raj, L. B., Shrestha, A., Acharya, K. 2017. Disease Pattern, Morbidity Indicators in a Tertiary Care Center of a Developing Country, Annals of Public Health and Research, Cilt. 4, s. 1055.
  • Bane, A., Bayisa, T., Adamu, F., Abdissa, S. G. 2016. Medical Admissions and Outcomes at Saint Paul’s Hospital, Addis Ababa, Ethiopia: a retrospective study, Ethiopian Journal of Health Development, Cilt. 30, s. 50-56.
  • Hernandez, C., Jansa, M., Vidal, M., Nunez, M., Bertran, M. J., Garcia-Aymerich, J., Roca, J. 2009. The burden of chronic disorders on hospital admissions prompts the need for new modalities of care: a cross-sectional analysis in a tertiary hospital, QJM, Cilt. 102, s. 193-202. DOI: 10.1093/qjmed/hcn172
  • Bloom, D.E., Ca ero, E.T., Jané-Llopis, E., Abrahams-Gessel, S., Bloom, L.R., Fathima, S., Feigl, A.B., Gaziano, T., Mowa , M., Pandya, A., Prettner, K., Rosenberg, L., Seligman, B., Stein, A.Z., Weinstein, C. 2011. The global economic burden of noncommunicable diseases, World Economic Forum, Geneva, 46s.
  • Boutayeb, A. 2006. The double burden of communicable and non-communicable diseases in developing countries, Trans R Soc Trop Med Hyg, Cilt. 100, s. 191-199. DOI: 10.1016/j.trstmh.2005.07.021
  • The World Health Organization. 2018. http://www.who.int/en/news-room/fact-sheets/detail/noncommunicable-diseases (Erişim tarihi: 17.01.2019).
  • Rietzschel, E. R., De Buyzere, M. L. 2018. Hypertension: time for doctors to switch the driver's seat?, Lancet, Cilt. 391, s. 914-916. DOI: 10.1016/S0140-6736(18)30317-9
  • Kessel, K. A., Vogel, M. M., Kessel, C., Bier, H., Biedermann, T., Friess, H., Herschbach, P., von Eisenhart-Rothe, R., Meyer, B., Kiechle, M., Keller, U., Peschel, C., Schmid, R. M., Combs, S. E. 2017. Mobile Health in Oncology: A Patient Survey About App-Assisted Cancer Care, JMIR Mhealth Uhealth, Cilt. 5, s. e81. DOI: 10.2196/mhealth.7689
  • Strehle, E. M., Shabde, N. 2006. One hundred years of telemedicine: does this new technology have a place in paediatrics?, Arch Dis Child, Cilt. 91, s. 956-959. DOI: 10.1136/adc.2006.099622
  • Sood, S., Mbarika, V., Jugoo, S., Dookhy, R., Doarn, C. R., Prakash, N., Merrell, R. C. 2007. What is telemedicine? A collection of 104 peer-reviewed perspectives and theoretical underpinnings, Telemed J E Health, Cilt. 13, s. 573-590. DOI: 10.1089/tmj.2006.0073
  • Piette, J. D., Valverde, H., Marinec, N., Jantz, R., Kamis, K., de la Vega, C. L., Woolley, T., Pinto, B. 2014. Establishing an independent mobile health program for chronic disease self-management support in bolivia, Front Public Health, Cilt. 2, s. 95. DOI: 10.3389/fpubh.2014.00095
  • Azar, M., Gabbay, R. 2009. Web-based management of diabetes through glucose uploads: Has the time come for telemedicine?, Diabetes Research and Clinical Practice, Cilt. 83, s. 9-17. DOI: 10.1016/j.diabres.2008.09.055
  • Agarwal, R., Bills, J. E., Hecht, T. J., Light, R. P. 2011. Role of home blood pressure monitoring in overcoming therapeutic inertia and improving hypertension control: a systematic review and meta-analysis, Hypertension, Cilt. 57, s. 29-38. DOI: 10.1161/HYPERTENSIONAHA.110.160911
  • McManus, R. J., vd. 2018. Efficacy of self-monitored blood pressure, with or without telemonitoring, for titration of antihypertensive medication (TASMINH4): an unmasked randomised controlled trial, Lancet, Cilt. 391, s. 949-959. DOI: 10.1016/S0140-6736(18)30309-X
  • Friedman, R. H., Kazis, L. E., Jette, A., Smith, M. B., Stollerman, J., Torgerson, J., Carey, K. 1996. A telecommunications system for monitoring and counseling patients with hypertension. Impact on medication adherence and blood pressure control, Am J Hypertens, Cilt. 9, s. 285-292. DOI: 10.1016/0895-7061(95)00353-3
  • Piette, J. D., Datwani, H., Gaudioso, S., Foster, S. M., Westphal, J., Perry, W., Rodríguez-Saldaña, J., Mendoza-Avelares, M. O., Marinec, N. 2012. Hypertension Management Using Mobile Technology and Home Blood Pressure Monitoring: Results of a Randomized Trial in Two Low/Middle-Income Countries, Telemedicine and e-Health, Cilt. 18, s. 613-620. DOI: 10.1089/tmj.2011.0271
  • Ferrante, D., Varini, S., Macchia, A., Soifer, S., Badra, R., Nul, D., Grancelli, H., Doval, H., Investigators, G. 2010. Long-term results after a telephone intervention in chronic heart failure: DIAL (Randomized Trial of Phone Intervention in Chronic Heart Failure) follow-up, J Am Coll Cardiol, Cilt. 56, s. 372-378. DOI: 10.1016/j.jacc.2010.03.049
  • Bellazzi, R., vd. 2002. A telemedicine support for diabetes management: the T-IDDM project, Comput Methods Programs Biomed, Cilt. 69, s. 147-161. DOI: 10.1016/S0169-2607(02)00038-X
  • Milani, R. V., Lavie, C. J., Bober, R. M., Milani, A. R., Ventura, H. O. 2017. Improving Hypertension Control and Patient Engagement Using Digital Tools, Am J Med, Cilt. 130, s. 14-20. DOI: 10.1016/j.amjmed.2016.07.029
  • Shoulders, B., Powell, L. 2019. Reaching for Goal: Incorporating the Latest Hypertension Guidelines Into Practice, The Journal for Nurse Practitioners, Cilt. 15, s. 102-109. DOI: 10.1016/j.nurpra.2018.09.011
  • Milani, R. V., Bober, R. M., Milani, A. R. 2017. Hypertension management in the digital era, Curr Opin Cardiol, Cilt. 32, s. 373-380. DOI: 10.1097/HCO.0000000000000405
  • Bode, B. W. 2000. Clinical utility of the continuous glucose monitoring system, Diabetes Technol Ther, Cilt. 2, s. 35-41. DOI: 10.1089/15209150050214104
  • Ndlovu, K., Littman-Quinn, R., Park, E., Dikai, Z., Kovarik, C. L. 2014. Scaling up a Mobile Telemedicine Solution in Botswana: Keys to Sustainability, Front Public Health, Cilt. 2, s. 275. DOI: 10.3389/fpubh.2014.00275
  • Fromme, H. B., Chen, C. O., Fine, B. R., Gosdin, C., Shaughnessy, E. E. 2018. Pediatric Hospitalist Workload and Sustainability in University-Based Programs: Results from a National Interview-Based Survey, J Hosp Med, Cilt. 13, s. 702-705. DOI: 10.12788/jhm.2977
  • Trent, S., Tatsubori, M., Suzumura, T., Tozawa, A., Onodera, T. 2008. Performance Comparison of PHP and JSP as Server-Side Scripting Languages, s. 164-182. Issarny, V., Schantz, R., ed. 2008. Middleware 2008, Springer, Berlin, Heidelberg, 428s. DOI: 10.1007/978-3-540-89856-6_9
  • Hu, X., Wang, L., Sheng, Z., TalebiFard, P., Zhou, L., Liu, J., Leung, V. C. M. 2014. Towards a service centric contextualized vehicular cloud. The fourth ACM international symposium on development and analysis of intelligent vehicular networks and applications, 21-26 Eylül, Montreal, Kanada, s. 73-80. DOI: 10.1145/2656346.2656351
There are 28 citations in total.

Details

Primary Language Turkish
Subjects Engineering
Journal Section Research Article
Authors

H. Cumhur Tekin 0000-0002-5758-5439

Publication Date January 24, 2020
Published in Issue Year 2020 Volume: 22 Issue: 64

Cite

APA Tekin, H. C. (2020). Kronik Hastaların Uzaktan İzlemine Yönelik Teletıp Platformu. Dokuz Eylül Üniversitesi Mühendislik Fakültesi Fen Ve Mühendislik Dergisi, 22(64), 37-46. https://doi.org/10.21205/deufmd.2020226405
AMA Tekin HC. Kronik Hastaların Uzaktan İzlemine Yönelik Teletıp Platformu. DEUFMD. January 2020;22(64):37-46. doi:10.21205/deufmd.2020226405
Chicago Tekin, H. Cumhur. “Kronik Hastaların Uzaktan İzlemine Yönelik Teletıp Platformu”. Dokuz Eylül Üniversitesi Mühendislik Fakültesi Fen Ve Mühendislik Dergisi 22, no. 64 (January 2020): 37-46. https://doi.org/10.21205/deufmd.2020226405.
EndNote Tekin HC (January 1, 2020) Kronik Hastaların Uzaktan İzlemine Yönelik Teletıp Platformu. Dokuz Eylül Üniversitesi Mühendislik Fakültesi Fen ve Mühendislik Dergisi 22 64 37–46.
IEEE H. C. Tekin, “Kronik Hastaların Uzaktan İzlemine Yönelik Teletıp Platformu”, DEUFMD, vol. 22, no. 64, pp. 37–46, 2020, doi: 10.21205/deufmd.2020226405.
ISNAD Tekin, H. Cumhur. “Kronik Hastaların Uzaktan İzlemine Yönelik Teletıp Platformu”. Dokuz Eylül Üniversitesi Mühendislik Fakültesi Fen ve Mühendislik Dergisi 22/64 (January 2020), 37-46. https://doi.org/10.21205/deufmd.2020226405.
JAMA Tekin HC. Kronik Hastaların Uzaktan İzlemine Yönelik Teletıp Platformu. DEUFMD. 2020;22:37–46.
MLA Tekin, H. Cumhur. “Kronik Hastaların Uzaktan İzlemine Yönelik Teletıp Platformu”. Dokuz Eylül Üniversitesi Mühendislik Fakültesi Fen Ve Mühendislik Dergisi, vol. 22, no. 64, 2020, pp. 37-46, doi:10.21205/deufmd.2020226405.
Vancouver Tekin HC. Kronik Hastaların Uzaktan İzlemine Yönelik Teletıp Platformu. DEUFMD. 2020;22(64):37-46.

Dokuz Eylül Üniversitesi, Mühendislik Fakültesi Dekanlığı Tınaztepe Yerleşkesi, Adatepe Mah. Doğuş Cad. No: 207-I / 35390 Buca-İZMİR.