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feat(proposal): start objectives section

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proposal/proposal.tex
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@ -32,18 +32,20 @@
\section{Background} \section{Background}
Early warning scores (EWS) have been widely adopted internationally to identify deteriorating patients\cite{downey_strengths_2017}. Medical deterioration is a critical concern in healthcare, particularly for vulnerable populations such as the elderly and chronically
ill patients. It refers to a decline in a patient's health status and may lead to adverse outcomes, including hospitalization,
longer stays in intensive care units, and increased healthcare costs.
Early warning scores (EWS) have been widely adopted internationally for early detection of deteriorating patients\cite{downey_strengths_2017}.
A large body of scientific evidence validates the effectiveness of EWS in assessing severity of illness, and in predicting adverse clinical events, A large body of scientific evidence validates the effectiveness of EWS in assessing severity of illness, and in predicting adverse clinical events,
such as severe deterioration, likelihood of ICU admission, and mortality, both on hospital wards\cite{subbe_validation_2001, buist_association_2004, paterson_prediction_2006, alam_exploring_2015, bilben_national_2016, brekke_value_2019} such as severe deterioration, likelihood of ICU admission, and mortality, both on hospital wards\cite{subbe_validation_2001, buist_association_2004, paterson_prediction_2006, alam_exploring_2015, bilben_national_2016, brekke_value_2019}
and in ambulatory care \cite{ehara_effectiveness_2019, burgos-esteban_effectiveness_2022, paganelli_conceptual_2022}. and in ambulatory care \cite{ehara_effectiveness_2019, burgos-esteban_effectiveness_2022, paganelli_conceptual_2022}.
Two common implemetations are the \textit{National Early Warning Score 2} (NEWS2) and the Two common implementations are the \textit{National Early Warning Score 2} (NEWS2) and the
\textit{Modified Early Warning Score} (MEWS)\cite{burgos-esteban_effectiveness_2022}. \textit{Modified Early Warning Score} (MEWS)\cite{burgos-esteban_effectiveness_2022}.
Both are calculated by capturing various vital parameters from the patient at a specific point in time, followed by numerical aggregation of the Both are calculated by capturing various vital parameters from the patient at a specific point in time, followed by numerical aggregation of the
captured data according to the specifically used score. captured data according to the specifically used score.
Traditionally, doctors and nursing staff perform collection and evaluation of the data manually, inputting data into an EWS-calculator by hand. Traditionally, doctors and nursing staff perform collection and evaluation of the data manually, inputting data into an EWS-calculator by hand.
Frequency of scoring, miscalculations and practical integration are known setbacks of NEWS2 and other scores\cite{eisenkraft_developing_2023}. Low frequency of scoring, miscalculations and practical integration are known setbacks of NEWS2 and other scores\cite{eisenkraft_developing_2023}.
% which is limited due to lack of resources\cite{shaik_remote_2023}.
Remote patient monitoring (RPM) can improve detection of deterioration\cite{shaik_remote_2023} by greatly reducing the Remote patient monitoring (RPM) can improve detection of deterioration\cite{shaik_remote_2023} by greatly reducing the
amount of human interaction required to take measurements and perform EWS calculations. amount of human interaction required to take measurements and perform EWS calculations.
@ -51,38 +53,52 @@ A number of studies have explored RPM combined with automated EWS calculation in
With hospitals facing critical patient demand during the SARS-CoV-2 pandemic, interest in exploring remote patient monitoring options surged, With hospitals facing critical patient demand during the SARS-CoV-2 pandemic, interest in exploring remote patient monitoring options surged,
and NEWS2 emerged as an effective tool for predicting severe infection outcomes\cite{gidari_predictive_2020, otoom_iot-based_2020, filho_iot-based_2021, carr_evaluation_2021}, and NEWS2 emerged as an effective tool for predicting severe infection outcomes\cite{gidari_predictive_2020, otoom_iot-based_2020, filho_iot-based_2021, carr_evaluation_2021},
while reducing person-to-person contact during patient monitoring. while reducing person-to-person contact during patient monitoring.
%Javanbakht et al. found that continuous vitals monitoring is more cost-effective than intermittent monitoring\cite{javanbakht_cost_2020}, however the findings of
%this study should be taken lightly due to potential bias reporting.
Since then, a variety of wearable medical sensors capable of continuously recording vital parameters have been developed and are Since then, a variety of wearable medical sensors capable of continuously recording vital parameters have been developed and are
commercially available\cite{noauthor_visi_nodate, noauthor_equivital_nodate, noauthor_vitls_nodate, noauthor_caretaker_nodate, noauthor_medtronic_nodate}. commercially available\cite{noauthor_visi_nodate, noauthor_equivital_nodate, noauthor_vitls_nodate, noauthor_caretaker_nodate, noauthor_medtronic_nodate}.
%Javanbakht et al. found that continuous vitals monitoring is more cost-effective than intermittent monitoring\cite{javanbakht_cost_2020}, however the findings of this study should be taken lightly due to potential bias reporting.
\section{Motivation} \section{Motivation}
Installing and operating traditional continuous monitoring systems, like the vital sign monitors used in medical facilities, demands
specialized equipment and technical expertise.
Furthermore, these systems are cumbersome for patients, as they involve connecting patient and sensor device with numerous electrodes
and cables, restricting patient mobility to the bed area, and physically tying the monitoring equipment
to a single location.
In contrast, battery-powered, wireless vitals monitoring devices, such as wearable arm- or wristbands, can incorporate multiple biosensors in a single device in a
much smaller form-factor, and allow for a much higher degree of patient mobility, rapid deployment and scalability\cite{un_observational_2021}.
Therefore, utilizing such devices for RPM is a suitable approach.
While the application of EWS in ambulant care facilities and hospitals has been thoroughly investigated, very little research has been done to While the application of EWS in ambulant care facilities and hospitals has been thoroughly investigated, very little research has been done to
assess their practicability for remote monitoring of at-risk patients at home. assess their practicability for remote monitoring of at-risk patients at home.
Some studies have examined monitoring individual vital signs for abnormalities using wearables for at-home-patients in a laboratory setting, Some studies have examined monitoring vital signs of at-home-patients for abnormalities in an experimental setting,
however in most of them, no automated EWS calculations were made\cite{archip_iot_2016, azimi_medical_2016, chowdary_efficient_2018, yeri_iot_2020, lee_all-day_2020, athira_design_2020, phaltankar_curaband_2021, thippeswamy_prototype_2021}. however in most of them, no automated EWS calculations were made\cite{archip_iot_2016, azimi_medical_2016, chowdary_efficient_2018, yeri_iot_2020, lee_all-day_2020, athira_design_2020, phaltankar_curaband_2021, thippeswamy_prototype_2021}.
Anzanpour et al. developed a monitoring system which collects vitals data and calculates EWSs in 2015, however due to limited or nonexistent In 2015, Anzanpour et al. developed a monitoring system which collects vitals data and calculates EWS, however due to limited or nonexistent
availability of remotely operable sensors for all vital signs relevant to EWSs, the work was limited to using a laboratory prototype availability of wireless sensors for all vital signs relevant to EWS, the work was limited to using a laboratory prototype
requiring some manual interaction in transferring vitals data\cite{anzanpour_internet_2015}. and required manual interaction in transferring vitals data\cite{anzanpour_internet_2015}.
Sahu et al. documented their development of an EWS-supported digital early warning system using the PM6750\cite{sahu_internet--things-enabled_2022}, Sahu et al. documented their development of an EWS-supported digital early warning system using the PM6750\cite{sahu_internet--things-enabled_2022},
an experimental vitals data monitoring device capable of taking continuous measurements in a laboratory setting\cite{noauthor_pm6750_nodate}. an experimental vitals data monitoring device capable of taking continuous measurements in a laboratory setting\cite{noauthor_pm6750_nodate}.
However, the methodology of real-time EWS calculation using data gathered in the laboratory is inconsistent and was not demonstrated. However, their methodology of real-time EWS calculation using data gathered in the laboratory is inconsistent and was not demonstrated.
Patients appreciate the face-to-face aspect of early warning score monitoring as it allows for reassurance, social interaction, and gives them further opportunity to ask questions about their medical care\cite{downey_patient_2018}. In summary, with the current availability of wearable, networked biosensors and the effectiveness of EWS in medical facilities, combining
both aspects presents an important and interesting research opportunity which could help reduce mortality and improve clinical outcomes
Taking continuous measurements is superior to measuring intermittently\cite{gronbaek_continuous_2023, shaik_remote_2023}, but for patients at risk of deterioration, both in their homes and on the go.
setting up continuous monitoring systems is cumbersome as it involves connecting patients to sensor devices
with numerous electrodes and cables, which restrict patient activities to the bed area\cite{un_observational_2021}.
Also, data transmission is highly reliant on in-house telecommunication infrastructure.
In contrast, wearable devices such as armband or wristband incorporates multiple biosensors in a single form-factor,
which allows a higher degree of patient mobility without the constraints of physical wirings.
More importantly, data transmission through cellular network avoids the need of installing additional in-house
telecommunication infrastructure, allows rapid deployment, and provides versatile and scalable solutions.
%Patients appreciate the face-to-face aspect of early warning score monitoring as it allows for reassurance, social interaction, and gives them further opportunity to ask questions about their medical care\cite{downey_patient_2018}.
%Taking continuous measurements is superior to measuring intermittently\cite{gronbaek_continuous_2023, shaik_remote_2023}.
\section{Objectives} \section{Objectives}
The objective of this research is to explore the feasibility of using an existing EWS for dismissed patients who are still at risk
of deterioration.
design and develop a web application that can capture and process vitals data from a wide range of
smart medical sensors, and accurately calculate the Modified Early Warning Score (MEWS) based on the captured data.
The application will be aimed at providing a mobile early warning system for patients at risk of deterioration, by providing real-time
data and alerts to medical professionals.
The proposed research will involve development of a robust and user-friendly web application interface.
The ultimate goal of this research is to provide a tool that can effectively monitor and predict medical deterioration,
thereby improving patient outcomes and reducing healthcare costs.
\section{Tasks} \section{Tasks}