GB2434458A

GB2434458A - Medical monitoring apparatus

Info

Publication number: GB2434458A
Application number: GB0601005A
Authority: GB
Inventors: David W Morgan
Original assignee: SAFE SURGERY SYSTEMS Ltd
Current assignee: SAFE SURGERY SYSTEMS Ltd
Priority date: 2006-01-18
Filing date: 2006-01-18
Publication date: 2007-07-25
Anticipated expiration: 2026-01-18
Also published as: GB0601005D0; GB2434458B

Abstract

A medical monitoring apparatus for monitoring a patient, the apparatus being operable to receive biometric data, attempt to establish a communication link with a remote system, if the communication link is established, transmit the biometric data to the remote system, and if the communication link is not established, perform classification step using the biometric data, retrieve guidance information in accordance with the classification step, and present the guidance information to a user. The apparatus finds particular use in in-flight emergencies where immediate access to medical assistance is not available. In use a user attaches medical devices to the patient which initialize and transmit biometric data to the monitoring apparatus. If a communication link can be established the acquired data is transmitted to the remote system where a medical advisor can review the data and provide guidance. If no link can be established, the apparatus can operate autonomously and supply guidance to the user in response to the classification step.

Description

Title: Medical Monitoring Apparatus Descrirtion of Invention This

invention relates to a medical monitoring apparatus, particularly but not exclusively for use in an aircraft.

It is a common problem that when a person abruptly falls ill or otherwise requires medical assistance, in many circumstances immediate access to medical assistance will not be available. A particular example of this is on an aircraft, particular domestic or International commercial passenger flights where a relatively large number of people will be travelling. In one survey, it was found that in-flight medical emergencies occur one in every approximately 750 flights. To assist in in-flight medical emergencies, aircraft carry enhanced medical kits and cabin crew are trained in their use, but in many circumstances expert medical advice would be desirable. It is known for medical advice to be obtained from a ground-based institution by means of the cabin crew relaying information via the aircraft's radio communication system, * .. . but this is an inefficient means of passing information to any medical advisor S...

on the ground and the cabin crew attending the patient may not be able to supply or even identify the appropriate information needed to transmit it.

Under such circumstances, the flight may have to be diverted to secure medical assistance as soon as possible, with a consequent impact on the other passengers and the operation of the airline.

It will be apparent that there are other situations, such as on oil rigs, where immediate medical assistance may similarly not be available.

Remote medical monitoring systems are known, for example from US5441 047 which shows a home based system and US6409661 which shows a system for an aircraft. In each example, the system obtains patient data and transmit it to a remote system, such as a medical expert located at the hospital or other facility. However, both these systems are reliant on a communication link being established and maintained with the remote system.

An aim of the present invention is to reduce or overcome one or more of the above problems.

According to a first aspect of the invention, we provide a medical monitoring apparatus for monitoring a patient, the apparatus being operable to receive biometric data, attempt to establish a communication link with a remote system, if the communication link is established, transmit the biometric data to the remote system, and if the communication link is not established, perform a an analysis step using the biometric data, retrieve guidance information in accordance with the analysis step, and present the guidance information to a user.

The apparatus may be operable to receive biometric data from a plurality of sensing devices. S...

S

The apparatus may be operable to generate a medical index in response to the biometric data and generate an output in accordance with the medical S...

: index.

S

* *..SS The apparatus may be operable to obtain further biometric data in accordance with the output.

The output may be a prompt to operate one of the sensing devices to obtain further biometric data therefrom.

The analysis step may be performed by a neural network.

The guidance information may identify a condition of the patient and provide information relating to the care of the patient.

The guidance information may relate to one or more of the following conditions asthmatic episode, allergic reaction and heart abnormality.

When no communication link is established the apparatus may be operable to repeatedly attempt to establish a communication link.

When a communication link is established and the communication link may be interrupted, the apparatus may be operable to store the biometric data and transmit the biometric data to the remote system when the communication link is re-established.

When a communication link may be established, the apparatus may be operable to perform a classification step and transmit the results of the classification step to the remote system. *0*

The classification step may be performed by the neural network. S..

* : The apparatus may be operable to receive information from the remote :* system and display the information to a user.

The information may comprise video information.

The apparatus may be operable to obtain picture data from a camera and transmit the picture data to the remote system.

The apparatus may be operable to connect to a communication system of the aircraft to establish the communication link with the remote system.

The communication system may comprise a broadband communication system.

The biometric data may relate to at least one of the following, electrocardiogram data, blood oxygen saturation, blood pressure, stethoscope data, peak expiratory flow rate, forced expiratory volume, and blood sugar.

An embodiment of the present invention will now be described by way of example only with reference to the accompanying drawings wherein: Figure 1 is a diagrammatic illustration of an apparatus embodying the present invention, Figure 2 is an illustration of the operation of the apparatus of Figure 1 in a first mode of operation, * IS* Figure 3 is an illustration of the operation of the apparatus of Figure 1 in a * second mode of operation, *. 20 Figure 4 is an illustration of a first display generated by the apparatus of * S..

Figure 1, S.... * .

Figure 5 is an illustration of a second display generated by the apparatus of Figure 1, Figure 6 is an illustration of a further display generated by the apparatus of Figure 1 and, Figure 7 is an illustration of a yet further display generated by the apparatus of Figure 1.

Referring now to Figure 1, an apparatus embodying the present invention is illustrated at 10. The medical apparatus 10 comprises an analysis module 11, a guidance library 12, a display screen 13 and a communication module 14.

The apparatus 10 is operable to communicate with a plurality of sensing devices 15, 16, 17, 18, 19, 20. The sensing devices 15 to 20 communicate with the apparatus 10 through a data buffering an signal processing layer generally shown at 21.

The apparatus 10 is operable to receive images from a digital video camera shown at 22 and through the communications module 14 can communicate through a wireless connection generally illustrated at 25 with a remote system 26.

The sensing devices in the present example comprise a blood sugar monitor * device 15, a pulse oximeter device 16, a 12-lead electrocardiogram device 17, a blood pressure sensor 18, stethoscope device 19 and a lung function meter device 20. The sensing devices operate as follows: * S.. S..

12-lead electrocardiogram (EGG): in this instance, a device for analysing the electrical characteristics of the patient's heart muscles and as such a useful S...

: non-invasive tool for assessing cardiac competence. The device attaches to :: the patient via a series of electrodes which are placed on the patient's chest and abdomen given appropriate clinical guidance. The output of the device is a plurality of real-time electrical waveforms.

Pulse oximeter: in this instance, a non-invasive device which attaches to either (non-exhaustively) the patient's index finger, ear lobe or toe. The output of the device is a measure of blood oxygen saturation (typically measured as a percentage), and a pulsatile waveform describing cardiac competence.

Blood pressure device: in this instance, a device for non-invasively determining the patient's blood pressure. The sensory part of the device is an inflatable cuff which wraps around the patient's arm. The device inflates and deflates the cuff and audibly determines the blood pressure of the patient.

Electronic stethoscope: in this instance, an acoustic device used for auscultating (i.e., listening to) the heart and lungs of the patient. The sensory part of the device is pressed against the chest of the and the output of the device is an electrical waveform describing the audible heart and lung sounds.

This is a useful tool in determining cardiac and respiratory competence.

Lung function: In this instance, the device is used for capturing lung function information, in particular, the competence of the lungs in inhaling, retaining and exhaling air. It is used to determine respiratory competence. Data output * is Peak Expiratory Flow Rate (PEFR) and Forced Expiratory Volume (FEy). S.. S.

Blood Sugar: in this instance, the device is an invasive device that tests the :r amount of glucose in the patient's blood. It is used to determine whether the patient's state is due to insufficient blood glucose. It is an indication as to whether the patient is diabetic and suffering from a hypoglycaemic episode. I....

In the present example, the ECG device 17 and the pulse oximeter device 16 operates continuously, while the other devices 15, 18, 19, 20 are used to collect data intermittently as required, and may require the intervention of a user to operate them.

The analysis module 11 is operable to process the data received from the sensing device 16, 17, 18, 19, 20 and perform analysis and classification steps on the data to provide an appropriate output.

Firstly, the analysis module 11 is operable to generate a Modified Emergency Warning Score (MEWS). MEWS a medical index which is calculated on the basis of physiological data from the patient in known manner which can help provide an indication of the clinical risk in the patient and can be used to indicate when treatment or further information is required). In the present example, the analysis module 11 calculates the MEWS and is operable to generate an output either prompting a user to operate one or more of the sensing devices 15 -20 or indeed automatically operate one of the devices 15 -20 appropriate to obtain further biometric data.

The analysis module 11 is also operable to perform a classification step using the biometric data to identify the condition of the patient. Advantageously, this can be implemented by use of a neural network such as a multi-layer perceptron. A neural network is a structure of processing elements that are * connected to form a network. Each processing element (henceforth referred I..

to as neuron') has a series of inputs, an activation function, and an output.

Each neuron sums the weighted product of its inputs and then translates the result through its activation function, issuing the result as its output. Typically, the neural network is constructed of layers of neurons, therefore the output of a layer of neurons is propagated to the input of the subsequent layer. The neural network learns to categorise the groups / classes of data by iteratively S....

adapting a translation model that translates the input pattern to a class assignment at the output (a process referred to as learning'). Therefore, a future pattern presented to the neural network can be subjected to the translation model and therefore be classified. The neural network is trained to identify patterns or characteristics of the biometric data and classify the data accordingly to identify a condition. It is known to use neural networks to classify cardiac problems using neural networks, for example as set out in Folland, R., Hines, E.L., Boilot, P. and Morgan, D.W., "Classifying coronary dysfunction using neural networks through cardiovascular auscultation", Medical & Biological Engineering & Computing 40(3), 2002, pp.339-343, and to classify respiratory and lung problems, for example as shown in Folland, R., Hines, E.L., Dutta, R., Boilot, P. and Morgan, D.W., Comparison of neural network predictors in the classification of tracheal-bronchial breath sounds by respiratory auscultation, Artificial Intelligence in Medicine 31(3), 2004, pp.211 -220.

Advantageously, the neural network may comprise an artificial neural network and particularly a conditional probalistic neural network as taught in our co-pending application number GB0309753.2.

The medical apparatus 10 may be provided in any appropriate form function as desired, for example as a tablet PC, although an appropriate formal function may be required. The medical apparatus 10 displays information to a user on the display screen 13, which may also be a touch screen operable to accept inputs or instructions from a user. The apparatus 10 may be * : connectable to the sensing devices 15 -20 by a physical connection such as I...

* leads or by a wireless connection such as a Bluetooth link. The wireless I. connection 25 may be any appropriate connection or series of connections as S...

: 20 desired, for example a wireless Internet 802.11 connection to a : communication network of the aircraft, and then a broadband communication link from the aircraft to a remote system 26 such as a hospital or other healthcare institution. Any appropriate link able to carry the required volume of data can of course be used as desired. The digital video camera 22 can be used to transmit images of the patient to the remote system 26, or may be used to establish a video conference link between a user and a technician or other medical advisor at the remote system 26.

The system operates as follows. In the event of an in-flight medical emergency, a member of the cabin crew or other appropriate user attends to the patient. The user attaches the medical devices 15 to 20 to the patient, which initialise and transmit biometric data to the medical monitoring apparatus 10, as shown at step 30 in Figure 2.

As shown at step 31, the medical monitoring apparatus 10 through the communication module 14 will attempt to establish a connection with a remote system 26, and, as shown at 32, will establish a separate thread to continue to establish a connection. If a connection is established, then at step 33 the acquired data is transmitted to the remote system 26, and is displayed on the display screen 13 as illustrated in Figure 4. The medical advisor at the remote system 26 is able to review the acquired and displayed data at step 33 and able to arrive at a clinical decision. The remote system 26 transmits instructions to the medical monitoring apparatus 10 to instruct the medical monitoring apparatus 10 to display an appropriate guidance information from the guidance library 12 to the user.

SS

S..... The three most common medical emergencies in-flight are asthma attacks, cardiac problems and allergic reactions, and an appropriate screen is *.S.

* displayed to the user in response to the instructions received from the remote *.* system as shown at 34, 35 and 36. S.. : 20

The guidance information is displayed to the user to enable then care for the patient. The medical advisor at the remote system 26 can also transmit further information notes, guidance videos and other information of use to the apparatus 10 to assist the user and can also establish a video link using the digital camera 22 to communicate with the user or view the patient. The biometric data can be continued to be collected by the medical apparatus 10 and transmitted throughout the system 26 so that the clinician can be aware of the outcome of the patient care being supplied by the user. The apparatus 10 will continue to control the frequency at which biometric data is obtained from the devices 15 -20 in response to the calculated MEWS result, although preferably these can be overridden by the medical advisor at the remote system 26 by sending instructions, or by the user in response to instructions from the remote system 26.

Figure 3 illustrates the operation of a medical apparatus 10 when no connection is established, Steps 30, 31, 32 are as discussed above with reference to Figure 2 but, as indicated by arrow 37, a connection is not successfully established. This may be decided by, for example, lack of any response from a remote system through a time-out. At step 38, the medical apparatus 10 acquires and displays the data to the user for example as shown in Figure 4. The analysis module 11 carries out a classification step, and in accordance with the output of the classification step identifies the relevant guidance information stored in the guidance library 12 and displays it to the user on the display screen 13. For example, if the biometric data from the lung function meter device 20 and pulse oximeter device 16 indicate lung problems and low blood oxygen consistent with an asthma attack, the asthma I...

screen as shown in Figure 5 will be shown to the user and the appropriate guidance information will be retrieved from the guidance library 12 and displayed to the user. As shown by arrow 41, the medical apparatus 10 will continue to obtain biometric data from the patient, in the present example in * *** : 20 accordance with the MEWS result and repeat the analysis step accordingly. If a connection is established by the worker thread 32, as shown at 42 the acquired biometric information, the outcome of the classification step 39 and the relevant guidance information presented to the user can be transmitted to a remote system 26 to enable the medical advisor to come to a clinical decision and provide further advice to the user. The apparatus 10 can also supply guidance information to the user based on the MEWS result to enable the patient's condition to be stabilised.

An example of a display screen presented to a user on initialisation is shown in Figure 4. The information from at least devices 16 and 17 is obtained and displayed, whilst the device is attempting to establish a connection as shown at step 32. The initial display 50 displays the obtained biometric data to the user as listed below.

BP/P: Blood pressure and pulse rate (from the blood pressure device) 02 Satn: Arterial 2 (oxygen) saturation (from the pulse oximeter) Camera: Video conference camera still image acquisition Vid Conf: Video conference image of remote site Steth: Electronic stethoscope sound trace waveform P/Flow: Lung function response (peak flow) Temp: Electronic thermometer readings B.S.: Blood sugar readings MEWS: Modified Early Warning Score The arrows shown on the display 50 allow the user to select the relevant biometric data to be displayed as a full screen. The MEWS results displayed in the figure at 51 can prompt the user to operate one or more of the correcting devices 15 -20, or indicate when the apparatus 10 is itself S. * operating the appropriate devices. S..

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: 20 As shown in Figure 2, the apparatus 10 may provide an appropriate guidance screen to the user in response to a clinical decision by a medical advisor at the remote system 26. For example, in Figure 5, a display 60 relevant to an asthmatic episode can be shown. The user enters information relating to the patient's age, height and sex, shown at 61, from which the expected peak flow readings can be calculated as shown at 62. The peak flow trace 63 and oxygen saturation values are displayed on appropriate guidance information is displayed to the user at 65. The apparatus method 10 will also transmit the biometric data to the remote system 26, and, if a classification step has been performed by the analysis module 11, this information is also transmitted to the remote system 26.

Where the patient is suffering from an allergic reaction, this can affect the patient's cardio-pulmonary function and it is this information that is displayed by the apparatus 10. Accordingly, the screen 70 shows at 71 the peak flow trace of the patient, at 72 the EGG trace, at 73 the blood oxygen saturation trace and at 74 the blood pressure and pulse information. As before, the user enters the patient's age, height and sex as shown at 75 from which the predicted peak flow can be calculated as shown at 76. The apparatus 10 can then assess recorded values against the predicted value perform a classification step, transmit the results of classification step and the biometric data to remote system 26 and display guidelines at 77 to the user. Similarly in Figure 7, a screen 80 or where the patient is suffering a cardiac problem is displayed, with the EGG trace shown at 81, the blood pressure and pulse trace shown at 82 and the oxygen saturation trace shown at 83. The appropriate guidelines are displayed to the user at 84, for example a video on how to perform CPR as shown at 85. *SS.

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* Accordingly, the medical apparatus 10 as discussed above enables detailed S..

biometric data to be captured from a patient during an emergency where there *: 20 is no immediate source of medical advice and either transmit that information * : * . and the results of a classification step to a remote system 26 once a connection has been established, or operable autonomously to perform a classification step and supply guidance information to a user in response to the classification step where no connection is established.

When used in this specification and claims, the terms "comprises" and "comprising" and variations thereof mean that the specified features, steps or integers are included. The terms are not to be interpreted to exclude the presence of other features, steps or components.

The features disclosed in the foregoing description, or the following claims, or the accompanying drawings, expressed in their specific forms or in terms of a means for performing the disclosed function, or a method or process for attaining the disclosed result, as appropriate, may, separately, or in any combination of such features, be utilised for realising the invention in diverse forms thereof. S. * S * S.. S... * S *SSS S...

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Claims

Claims 1. A medical monitoring apparatus for monitoring a patient, the

apparatus being operable to: receive biometric data, affempt to establish a communication link with a remote system, if the communication link is established, transmit the biometric data to the remote system, and if the communication link is not established, perform classification step using the biometric data, retrieve guidance information in accordance with the classification step, and present the guidance information to a user.

:... 15
2. An apparatus according to claim 1 operable to receive biometric data S...

S..... from a plurality of sensing devices. S...

3. An apparatus according to claim 2 operable to generate a medical index in response to the biometric data and generate an output in accordance : 20 with the medical index. S.I * S

4. An apparatus according to claim 3 operable to obtain further biometric data in accordance with the output.

5. An apparatus according to claim 3 or claim 4 wherein the output is a prompt to operate one of the sensing devices to obtain further biometric data therefrom.

6. An apparatus according to any one of the preceding claims wherein the classification step is performed by a neural network.

7. An apparatus according to any one of the preceding claims wherein the guidance information identifies a condition of the patient and provides information relating to the care of the patient.

8. An apparatus according to claim 7 wherein the guidance information relates to one or more of the following conditions; asthmatic episode, allergic reaction and heart abnormality.

9. An apparatus according to any one of the preceding claims wherein when no communication link is established the apparatus is operable to V repeatedly attempt to establish a communication link.

10. An apparatus according to any one of the preceding claims wherein when a communication link is established and the communication link is *eS.

interrupted, the apparatus is operable to store the biometric data and transmit the biometric data to the remote system when the communication link is re- * established. *.* *

*: 20 11. An apparatus according to any one of the preceding claims wherein, when a communication link is established, the apparatus is operable to perform the classification step and transmit the results of the classification step to the remote system.

12. An apparatus according to claim 11 where dependent directly or indirectly on claim 6 wherein the classification step is performed by the neural network.

13. An apparatus according to any one of the preceding claims operable to receive information from the remote system and display the information to a user.

14. An apparatus according to claim 13 wherein the information comprises video information.

15. An apparatus according to claim 14 operable to receive picture data from a camera and transmit the picture data to the remote system.

16. An apparatus according to any one of the preceding claims for use on an aircraft, the apparatus being operable to connect to a communication system of the aircraft to establish the communication link with the remote system.

17. An apparatus according to claim 16 wherein the communication system comprises a broadband communication system. .. .

18. An apparatus according to any one of the preceding claims wherein the biometric data relates to at least one of the following; electrocardiogram data, * blood oxygen saturation, blood pressure, stethoscope data, peak expiratory S..

flow rate, forced expiratory volume, and blood sugar. * S.. : 20

19. An apparatus substantially as described herein and/or with reference to the accompanying drawings.

20. Any novel feature or novel combination of features described herein and/or in the accompanying drawings.