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Application of Embedded System for Home Care and Health Management
Jyh-Perng Fang and Yang-Lang Chang National Taipei University of Technology, Taipei, Taiwan Abstract
Non-compliance and inappropriate usage of medication are common problems found among the elderly, especially in the environment of home care. To address these problems, a drug dispenser is developed with the following goals: (1) to provide an intelligent medication reminder device, (2) to construct a remote monitoring mechanism to check for continuous medication compliance, and (3) to implement the whole system in an acceptable cost, and (4) to minimize the power consumption of the whole system. The proposed drug dispenser is not only useful in the environment of home care but is suitable for health management as well. Keywords - home care, health management, drug dispenser, embedded system. Introduction
and other disabilities such as dementia [3, 4]. With the boost of aging population around the world, Traditionally, medication is considered as the most non-compliance of medication has become the major preferred treatment after visiting a doctor. For example, source that degrades the effect of medical treatment. For averagely a person visits outpatient clinics in Taiwan the medications cost in nursing homes, it is estimated more than ten times per year and a physician prescribes that more than one-thirds is needed to manage over four kinds of drugs on average during each visit. medication-related events [5]. In addition, it frequently While medication assists a patient recovering from causes unnecessary request for emergency services and attack of sickness, to take a large combination of drugs preventable visits to hospital, which accordingly raise implicates that a patient is exposed to a high risk of the healthcare expenditure for the elderly. medication non-compliance, improper medication usage, Taking medication at wrong time, or not taking and adverse drug interactions [1, 2]. These are referred right dosages as prescribed by physicians are examples as the polypharmacy problems, which are concerned of non-compliance and improper medication usage. To especially for the elderly patients. On account of the remind patients when and how much to take their compound of multiple chronic diseases, it is unseldom medication, there has been kinds of medication that the elderly patients visit physicians with different compliance aids devices introduced [6-8]. For example, specialties and bring home a larger combination of one such a medication device have weekly-based daily medication than average-age patients do. Consequently, compartments, which are each divided into sections. the elderly patients are more susceptible to the problems Each section in a compartment corresponds to a of polypharmacy and thus to the risk of adverse specified time point of a day, e.g., breakfast, lunch, reactions because of unwanted or unpredicted drugs evening meal, and night meal. Even if these medication devices provide certain assistance for patients in their Non-compliance of medication origin from medication usage and compliance, those devices are declining cognition caused by the natural aging process This work was supported by the National Science Council, Taiwan, under Grant No. NSC 93-2215-E-002-010/006. (1) The device works only if the patient is automatically dumped into the cup. If the switch is not pressed for a predefined time period after the audio (2) Most of the devices are not active reminder alarm beeps for taking medication, not only a remote connection is immediately initiated to invoke necessary (3) There is no logging function provided for actions, but a log mechanism (not shown) is started to (4) Mechanism for preventing adverse drug reaction management cost of ADR is the same as the cost of prescribed medication. An important yet preventable type of ADR is the interaction between drugs. As the elderly usually have multiple chronic diseases treated by physicians with different specialties, these patients frequently received medication from different doctors without double-checking for unwanted drug interaction. Therefore it is important to have a patient safety device The drug dispenser includes the following key II. Methodology.
Basically, the drug dispenser proposed works as a multi-function medication reminder, which not only serves as an assistant for medication compliance of (1) Manual loading to and auto unloading from home-cared elderly, but helps ordinary adults who take The drug dispenser contains a drug-dumping chute (2) Timed release function that limits the access that a patient can take drugs from while functions for reminding, monitoring, logging, and communication are (3) Timed alarm function with time display and reminding alarm are provided to indicate that An illustrative view of the drug dispenser as proposed is shown in Fig. 1, in which time display and alarm components are attached, and compartments are B. Adverse Drug Reaction Prevention. each divided into sections for loading distinct drugs for specified time for medication. The drugs are loaded Table 1 shows the most popular method to manually once every two or three days. Each section quantify clinical significance of drug interactions. corresponds to a kind of drug at specified time for Two dimension (severity and documentation) rating medication, and drugs in one or more sections are scales are used to classify 5 levels of significance. dumped at each specified time for medication. Level 1 represents the most severe drug interaction. Whenever time for medication is due, audio alarm is Level 2 represent moderate severity. Level 3 to 5 are activated to remind the patient that it is time to take rated as minor severity or not well documented. medicine. The patient or the one who is responsible for Table 2 has two examples of drug interaction taking care of patient accordingly puts a cup under the pair. In this study only level 1 (about 100 pairs of dumping chute. After pressing a switch, drugs are drug interaction) and level 2 (about 200 pairs of Table 1: The drug interaction significance scale Whenever the compliance of medication is violated, the alarm mechanism is initiated accordingly, which includes voice/visual alarm, and the drug dispenser is remotely connected to the host site automatically such that the medical personnel at the host site can communicate with the patient at the drug interaction) are included in the database of the client site or take necessary actions in time. To meet the requirement of medication compliance monitoring, auto dial as well as short message Table 2: Examples of drug interaction with level 1 III. Power Saving
Aminoglycosides: Loop
The drug dispenser introduced in this paper is Diuretics
indeed an SOC-based embedded system [10], on which a motor-control mechanism, a certain amount of sensors, and a wired/wireless network interface [11] are equipped to afford the medication-compliance related functions described above. The system is experimentally developed both on platforms as shown in Fig. 3(a) and 3(b), where Fig. 3(a) is an 8951-based circuit and Fig. aM1A: Perform baseline hearing test b 3(b) is an S3C4510-based circuit. However, to drive the M1B: Periodic monitoring hearing test cM1C: Dose of one or both drugs in renal dysfunction patients whole system, a significant amount of power is required dM2A: Monitor hemodynamic function [12]. To save the power consumption in such an eM2B: Administer inotropic, chronotropic and pressor support embedded system, a software-based power saving In the following, techniques for reducing A look up table (LUT) based on Table 2 is built into communication time and code optimization [13] are the drug dispenser, as shown in Fig. 2, in which the described, in which the hardware as well as operating adverse dugs [9] are cross-referenced. In the LUT, system are assumed to have been decided as shown in not only the drugs with adverse effect are recorded, shadowed region in Fig. 4(a). Also, for clarity, the but the effect and the management steps may be procedure of system configuration that typically used for listed as well. Whenever a drug name is entered, the dismounting redundant drivers, as shown in Fig. 4(b) is drug dispenser automatically searches LUT to not introduced herein. identify the condition of adverse drugs. To implement this feature, a database of drugs is A. Command-driven communication Handle for message rather than message itself is transferred during communication, the receiver treats the received handle as an index on a pre-built message table for retrieving real message. Adequate algorithms such as dynamic programming are adopted to avoid wasting resource caused by For example, operations of multiply or divide are replaced with operations of add or subtract. Further, some operations of multiply or divide are replaced D. Reduction of overhead on control-transfer For example, function calls are replaced with IV. Implementation
macros, the overhead on control-transfer is thus The drug dispenser is developed following an incremental and iterative design process [14]. Generally speaking, in phase I, functions for For example, frequently used variables can be medication reminding are involved. Also, tradeoffs declared to reside in registers rather than memory. between accuracy as well as portability and power efficient are simultaneously considered in this phase. In phase II, a LUT is integrated into the drug Idle devices are turned off through software control. dispenser and interactive mechanism is provided to detect ADR. In phase III, the system will be G. Always route through a less power-consumption deployed in the nursing home and/or hospitals in order to evaluate its effectiveness as well as its For example, suppose there are two paths available feasibility. For each design phase, as a part of the for communicating with the host site: wired and incremental and iterative design process, the drug wireless. The wired path will be a better choice dispenser is incrementally improved in accordance with the evaluation results during previous design V. Conclusions
non-compliance and inappropriate usage of medication. The design phase is incremental and iterative. As an Fig. 3: Platform for developing drug dispenser SOC-based embedded system, its major functionalities have been simulated and its power consumption has been analyzed and ameliorated on developing platforms. A prototype has been constructed according to the analyses and evaluations performed in preceding design phases and is now used as a vitamin dispenser on a daily base. What has been verified in the trial use includes the functions of medication reminding, mechanism of loading and dumping drugs, and the ability of remote In the long run, it is expected that the whole design Francesco LEE. Mitchell, Joyce A., “Electronic will promote the medical compliance and ADR Communication With Patients: Evaluation of Distance preventions such that the problems of elderly with Medicine Technology,” JAMA, 278(2):152-159, July 9, polypharmacy are effectively ameliorated. [12] htm, Acknowledgement
Semiconductors,” ITRS 2003 Edition. An experimental version of drug dispenser in this [13] B. Tabbara, A. Tabbara, A. Sangiovanni- Vincentelli, work was partly supported by the National Science “Function/Architecture Optimization and Co-Design of Council, R.O.C., under Grant NSC 93-2215-E-002- Embedded Systems,” Kluwer Academic Publisher, 2000. [14] A. Tomer and S. R. Schach, “The Evolution Tree: A Maintenance-Oriented Software Development Model,” Proc. The 4th European Conference on Software References
Maintenance and Reengineering, Zurich, Switzerland, pp. [1] Nananda C, Fanale JE, Kronholm P, “The role of [15] H. Chang, L. Cooke, M. Hunt, G. Martin, A. McNelly, L. medication noncompliance and adverse drug reactions in Todd, “Surviving the SoC Revolution,” Kluwer Academic hospitalizations of the elderly,” Arch Intern Med, [16] Michael Keating, Pierre Bricaud “Reuse Methodology [2] Bootman JL, Harrison DL, Cox E., “The healthcare cost of Manual,” Kluwer Academic Publisher, 2002. drug-related morbidity and mortality in nursing facilities,” Arch Intern Med, 1997;157:1531-1536, [3] Pray W. S., Bullman R., Covington TR, “OTC medicines update. In the over-the-counter market, new products and added indications provide an important opportunity for pharmacists,” Journal of the American Pharmacists Association: JAPhA, 43(5 Suppl 1):S28-9, 2003. [4] [5] Bullman R., “Educate before you medicate: your lifeline for safe medicine use,” FDA Consumer. 35(5):40, 2001. [6] HealthWatch100, medical_ [7] MED-Companion II, [8] TAGSYS Products,, 2003. [9] Davie S. T., “Drug interaction facts. Facts and Comparisons,” R A wolters Kluwer Company, Drug information analyst, San Carlos, California. [10] F. Vahid, T. Givargis, “Embedded System Design,” John [11] Balas E. Andrew, Jaffrey, Farah Kuperman, Gilad J. Boren, Suzanne Austin, Brown, Gordon D, Pinciroli,


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