Hospital Clinical Management Category

Hospital clinical management refers to health management and clinical administration in a hospital.

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This category includes all hospital clinical management submissions:

[Team 100] Pre-fall Detection Mat

Many times in healthcare settings, fall occurs due to several reasons that made patient leave the bed without assistance, often over estimate their mobility ability which caused misjudgement and lead to fall. Aside from the manpower constraints, the private wards such as A and B1 class are designed to be single bedded in one room or four bedded in one cubicle. It will take extra time and effort for nurses to visit every room or cubicle to check on the patients. In some cases, incident does happen in the last room/cubicle, nurses may not hear anything if they were in the first room/cubicle which is on the other end of the ward. Sustaining fall not only inflicts physical injuries to patient, but also increases the psychological stress of the patient’s family and patient him/herself. On top of that, it will also add on to their financial burden due to prolonged hospitalization stay. This team propose to have a thin pressure sensor mat to be installed in every bed and placed it between the mattress and bed frame. The pressure sensor mat will cover the whole area of the mattress so as to detect the patient’s position accurately. The moment patient attempt to leave the bed, the pressure sensor will alert the ward nurses based on the position of patient in bed e.g. right/left corner/edge of the bed. When pressure sensor mat detects the position of the patient that he/she is likely to attempt leaving the bed, it will send off alert to a wireless “receiving device” (preferably pager size device) which every nurse in the ward will hold one, and alert the nurses using sound tone, vibration and indicate which bed is sending the alert. Therefore, nurses can attend to the patient as soon as possible, to prevent patient leaving the bed and thus reduce the risk of fall to absolute minimum. 

This team is working with Ngee Ann Polytechnic from the Electrical Engineering Division to develop a solution. 

[Team 101] Code Blue 

We hope to design a new approach to clinical education delivered through the use of AR with high fidelity manikins. AR is able to overlay information and graphics onto the manikin, enabling trainees to obtain a visual and tactile sense of an emergency situation or training scenario. AR complements high fidelity manikins, allowing more clinical symptoms such as inflammation and changing of skin tone to be superimposed on to the manikin. With the use of AR more complex scenarios could be created as it allows us to change the clinical symptoms or situation during a simulation run, testing for nursing adaptability.AR also brings a new dimension of realism by allowing manikins to portray emotions such as sadness or pain, and psychological symptoms such as confusion and dazed. AR with gesture recognition feature adds an additional level of interactivity. We would be able to evaluate participants for proper execution of technical skills or actions, such as correct hand placement during cardiac compression, trainees can also receive instant prompts on their incorrect actions. AR aural and speech user interface (UI) would allow basic interaction with the manikin to develop trainee’s soft skills in managing patients. We hope that the training delivered through the use of AR with high fidelity manikin can be used to train team based scenarios, such as Code Blue trainings, where multiple roles are involved. 3 or more sets of AR glasses could be programmed to deliver a scenario simultaneously, allowing collaboration and enabling testing of team based decisions. The programming of the scenarios will combine real and virtual objects in a real hospital environment, allowing the trainees to interact with and have a full sensory awareness of the ward environment. This will help to create an authentic simulated experience.

This team is working with Advanced Remanufacturing and Technology Centre of A*STAR and Serious Games Hub of Temasek Plytechnic. ARTC is a platform built upon strong partnerships across the supply chain: complemented by technical support from research institutes and academia. The 1st Centre in Asia within the network of Advanced Research Centres (known as AxRCs), ARTC is headed by a capable core team. With a purpose built facility, underpinned with world class research expertise at A*STAR and NTU to rapidly create solutions and bring these technologies into industrial production capabilities to the benefit of all its stakeholders. 

 [Team 103] Intra-Layer Bandage Pressure Monitoring Device (iLP-BPM)

Treating venous ulcer can take from weeks to many years especially for open ulcers (Nelzén, Bergqvist, & Lindhagen, 1997). The mainstay of treatment has rather been conservative, with compression dressings and elevation of the extremity. Compression therapy has become widely accepted as the cornerstone of venous leg ulcer treatment since the development of the four-layer bandaging (Moffatt, 2005). Four-layer bandaging is a high-compression bandaging system (sub-bandage pressure 35-40mmHg at the ankle) that incorporates elastic layers to achieve a sustained level of compression over time. In the four-layer bandaging, a wool bandage is applied from the base of the toes to just below the knee joint. This is followed by the application of a crepe bandage. Next an elastic compression bandage is applied in a figure of eight, followed by a final cohesive layer. In order for compression therapy to be effective, there is the need to ensure adequate compression pressure but with poor technique, non-compliance and bandaging that loosen over time, it might defeat its purpose and will lead to longer healing time and complications such as wound infection (causing increasing pain), cellulitis, contact irritant dermatitis relating to exudation and bacterial colonisation, periostitis, osteomyelitis, osteoporosis and bony ankylosis of ankle (Collin, 2010). If inadequate pressure is not maintained, the patient will not benefit from the compression therapy. This will lead to longer healing time and also costly and inconvenient for patients who had to come back every week for the change of bandage. We need an equipment or a tool that can measure intra layer pressure that could provide a visual feedback that the right pressure is delivered and maintained. A visual feedback is important because it will allow the patient to do self-monitoring and when the pressure is inadequate i.e. not at a therapeutic level, they could make early arrangement for the bandage to be reapplied. In this way the efficacy of the compression therapy would be achieved. We also need the equipment to be small and light so it does not add weight or pressure on the dressing. Most importantly, the equipment is durable to be re-usable for single patient use and can be clean with a disinfected wipe at every change of bandage. Beside that it would also be useful for the nurses to know that the pressure is at a therapeutic level. Currently the nurses applied the 4-layer bandage according to subjective instructions i.e. following figure eight and only an inch to be overlapped between figure eight. We need a more objective measurement to know that the bandage is applying the right amount of pressure consistently for every patient. As mentioned earlier, pressure that is too high may affect microcirculation and pressure too little will defeat its purpose.

This team is working with the MechanoBioEngineering Laboratory in the National University of Singapore to develop the solution.

[Team 107] Moving BCLS Course to Automation

Every healthcare providers needs to be certified with Basic Cardiac Life support course as a requirement by Singapore Medical Board and Singapore Nursing Board. This Course is accredited by the National Resuscitation Council. Over 5000 healthcare providers needs to be recertified in Singapore General Hospital every 2 yearly. Statistic of 2016 shows 195 sessions per year required to train these healthcare providers. Each training session consists of 1 Chief Instructor and 5 trainers to train 30 trainees per day. 11 Chief Instructors and 24 trainers are being rotated per year and each Chief Instructors are required to teach 30 sessions. Each trainer are required to teach at least 20 session per year. Chief Instructor also spend time marking manual theory test. Chief Instructor and trainers are experiencing burnout. Every session, trainees has given feedback that time has been wasted due to other trainees who requires more coaching. Overall, there is a lot of time and manpower wastage to the current BCLS course.

The technology partner has yet to be confirmed. 

[Team 113] Development of an Enhanced Electrocardiogram (ECG) Machine for Quick Analysis in the Emergency Department (ED)

In the Emergency Department (ED), it is a requirement for ECG to be done within 10mintues at triage during the Point of Care Testing (POCT). It is a nurse-initiated order to specific types of patients with certain presenting complaints in order to determine the severity of illness. Even though new technologies continue to develop for diagnostic evaluations of patients with cardiovascular disease, the ECG retains its central role. However, there are many factors that contribute to the delay in performing ECG which may result in delay in patient treatment as well as longer waiting time. The ECG machines are often faulty due to fractured wires and high usage in the ED. It gets easily tangled especially in an emergency situation when multiple procedures are ongoing simultaneously. Bad connectivity can be caused by poor contact of the ECG electrodes and onto the patient’s body, poor skin integrity, chest wounds and hairs and often leads to failure to capture rhythm or produces non-useful erratic results. All these contributing factors lengthened time spent in performing an ECG which results in delaying treatment for impending life-threatening cardiovascular emergencies. Precious time is lost in troubleshooting ECG machine and delaying diagnosis as well as catheterization time to save the heart. Moreover, the machine out-look is bulky and heavy and requires bigger storage area or parking space in the clinical area. An ideal ECG would be a compact hand-held machine with wireless abilities and filtering functions to eliminate artifacts. Electrodes should have a skin-friendly conducting gel that sticks well onto skin but allow for painless removal. A minimum of 10 electrodes are needed per patient to produce a 12 lead ECG. The electrodes should be disposable as well to comply with infection control. They could have microchips on each electrode that is able to retrieve electrical rhythms and transmit them to a machine where 12 lead-ECG is produced. Elimination of long wires attached to the electrodes would solve entanglement and fracturing of wires altogether. The ECG machine should be small, compact and preferably hand-held so that it does not take up space in the clinical area. It should have wireless capabilities that allow ECG to be transmitted, printed and retrieved from a central bank (Heartstation). This cuts down time to search for a comparative previous ECG by having it printed from the same machine. An inbuilt programme that filters artifacts would greatly enhance ECG prints and allow a clear and definitive interpretation for the medical personnel. A better and improved ECG machine would be a viable diagnostic tool in the Emergency department. Capturing, transmitting and printing heart rhythms wirelessly, promptly and accurately would enhance patient care and allow the healthcare team to quickly diagnose life-threatening heart rhythms and provide appropriate treatment that could save their life.

The technology partner has yet to be confirmed. 

[Team 114] Resuscitation Team Game

Advance Cardiac Life Support (ACLS) competency crucial for optimal resuscitation and improved patient outcomes in the hospital. Currently, Health Care Workers (HCWs) undergo ACLS training in the form of didactic lectures and simulation. Competence is determined by an individual test after full ACLS Course or as ACLS Refresher Course. In reality, ACLS is a team effort; communication, mutual understanding and coordination between HCWs is paramount for a well conducted resuscitation. Hence, we propose the creation of a team based app via iOS/iPad to improve ACLS knowledge, team communication and coordination in a form of a short but intense game. 

The technology partner has yet to be confirmed. 

[Team 116] Airway Training

Airway management is an essential skill for doctors and first responders during a medical emergency. However, it is difficult to mass train people as there are limited resources. Some of the more challenging airway management scenarios may also be rare and difficult to train for. It is hoped that with this augmented reality program, we can engage and train more people, especially first responders, on the importance of basic to advanced airway management over a short period of time with existing or relatively less resources. This program enables trainees to learn basic to advance airway skills cognitively in a fun, engaging and safe environment.

This team is working with Fraunhofer IDM@NTU to develop this solution. Fraunhofer IDM@NTU is an enabler for various vertical sectors of the industry such as healthcare and medicine, urban solutions, smart manufacturing, maritime, logistics, marketing, training, education, and future learning.

[Team 120] Conceptualising the Next Generation Incentive Spirometry

Patients undergoing moderate to major operations often succumb to postoperative lung infections due to poor breathing efforts, resulting in partial collapse of the lungs. Pre-operative and post-operative chest physiotherapy is important to prevent lung infections. Another group of patients who are susceptible to lung infections are patients who have been on prolonged bed rest. Even amongst patients who already have lung infections, studies have shown that they may benefit from quicker recovery by using incentive spirometry to improve their breathing efforts. A device called incentive spirometry helps to motivate patients to inhale deeply, allowing for continuous chest physiotherapy even after their session with the physiotherapist has ended. The incentive spirometry requires the patient to inhale slowly and deeply through a mouthpiece until he/ she reaches the targeted volume, and then hold his/ her breath for 5 seconds. The device consists of an indicator which allows the patient to know when he/ she has reached the targeted volume, together with another indicator which lets the patient know if he/ she is inhaling too quickly. The incentive spirometry is effective because it provides visual cues to allow the patient to know the right volume and flow rate to breathe at. However, real life implementation of this device is let down by poor patient compliance. In order for patient to enjoy maximal gains from the use of the incentive spirometry, the patient must be self-motivated enough to use the device for at least 10 times an hour. We propose harnessing the use of gaming technology and kinetic flow sensors to translate patient’s breathing efforts into ‘mana/ magic points’ which will allow them to advance/ compete their characters in video games. 

This team is working with Serious Games Hub, Temasek Polytechnic to develop the solution. The School of Informatics & IT opened the TP-Autodesk Serious Games Hub on 17 August 2015. Students from the Diploma in Game Design & Development will be working within these spaces as part of their internship.

[Team 121] Sensor Alert System for Surgical Drainage Bottles

Commonly, the types of drains used for breast surgeries are known as the active drains. These low-pressure suction devices continuously remove fluids against gravity via a closed drainage system. The drain is attached to a collapsible reservoir that exerts negative pressure to pull accumulated fluids from the wound bed. The collection reservoir expands, as it collects drainage. These few active drains include Privac which holds a maximum volume of 500ml, the Unoplast and Blake drainage bottles which hold up to a maximum volume of 100ml. The above served the same principle in allowing easy assessing and monitoring and emptying of the drainage amount when half-full. This would decrease the chances of overflowing and maintain patency of the tubing instead of having fibrins clogging. There have been incidences, where nurses in the ward or patients who have been discharged home, observed to have not emptied their drainage bottle when half-full. This, in turn, can impact on inadequate drainage vacuum of the drainage bottles to provide an effective drainage system. Hence, resulting in the complication of hematoma, which is a collection of blood inside the surgical wound of a patient. When the blood builds up at the surgical site, it must be drained because its accumulation can cause swelling which can be painful and infection may developed. There are also tremendous amount of anxiety and problems arise among the patients, surgeons and Breast Care Nurses during these trouble-shooting sessions. If hematoma has developed, patient may need an immediate surgery to drain the blood, which is more costly, and adding physical and psychological discomfort for the patients. With such an intention to alleviate patient and family anxiety, coupled with the benefit in serving as a reminder for the nurses in the ward, we would like to propose a fun and innovative sensor alert system. The usability of this alarm system would provide adequate patient monitoring of the drainage bottles volume and vacuum control, keeping in mind that the ultimate goal is to provide the best interest for our patient care. We welcome manufacturers who are passionate in inventing an easy to use, user-friendly and intuitive and cost effective alarm system which could possibly revolutionised the surgical management of drain to allay the post-surgical anxiety in patients who are coping with their breast cancer diagnosis and in managing with their other existing psychosocial issues.

The technology partner has yet to be confirmed. 

[Team 126] Online CPE

Healthcare professionals including nurses are continuously being challenged to maintain the currency of their knowledge and skills to meet the ever-changing needs. They generally recognise that continuing professional education (CPE) is necessary if they are to maintain clinical competency and engage in effective and safe practises. CPE includes attendances at in-services, lectures, seminars, conferences and workshops, self-study and participating in or facilitating research events (e.g., by publishing papers and delivering oral/poster presentations). It is expected that the Singapore Nursing Board will require all nurses to engage in MCPE in the near future. Thus, the pressure on individual nurses to meet CPE requirements to maintain their professional registration and for employers to assist nurses to achieve this objective will increase. However, several challenges exist that may prevent nurses from participating in CPE. Common factors include time constraints, work commitments, limited opportunities to attend CPE courses and the cost of such courses. The online portal should have scalability and extensibility as online CPE could potentially attract participants from other healthcare institutions or the region. Currently, there are approximately 30,000 nurses in Singapore. If each nurse is required to complete a minimum of 15 hours CPE per year, there is a potential million-dollar CPE industry in Singapore.

This team is working with Connected Health Digital to develop the solution. Connected Health Digital builds innovative channels to connect, collaborate and continuously educate healthcare professionals across the globe.

 [Team 129] Learning New Ways to Peform Daily Tasks

Patients with recent disability need to re-learn lots of basic things. Simple thing that are usually taken for granted such as eating, dressing, grooming and bathing become challenging when weakness of the hands and trunk are present. For example those who have with hand weakness will find it difficult to even take their clothing and much more difficult to put them on. Though the tasks seems to be something minor or not important, people with disability values any sort of activities they can do independently. It is the source of their dignity and self-esteem. Early intensive training is beneficial for patients to develop skills to re-learn these activities. In the current practice the training can only start when patient have achieved reasonably good truncal control and strength. Before the patients could actually do it, they need to learn many small skills such as lifting their hands, taking their shirts, putting the hand into the shirt and so on. There are established techniques on how persons with different types of disability could wear their clothes. The therapists needs to teach them all these techniques; what the current therapy failed to do is to help patient visualised what are those small steps that they must undertake to enable them wear their clothes. What we would like to have is something that allows patients to visualise the techniques and steps what they need to do to relearn the skills. And that the intervention allows all these small steps they need to do even when patient is not physically ready to perform the actual activities. And an intervention that can provide motivation to achieve more, objective monitoring and documentation of patient progress, and adaptable to various types of disability.

The technology partner has yet to be confirmed. 

[Team 131] Improving Productivity in Physiotherapy Outpatient Service

Improving productivity has taken on an added urgency and priority in recent times, however, the drive to increase productivity in the health care sector has been challenging due to multiple factors. An area of concern would be the wastage of appointment slots in the outpatient physiotherapy clinic setting. In the outpatient physiotherapy setting, wasted slots mean a loss of clinical productivity. A physiotherapist’s schedule includes on average 15 patients per day. On average, there will be about 2 to 4 patients who do not attend their session which results in about a 20-30% wastage in slots. One way to tackle this problem would be to call the patient a day or a few hours prior to their appointment time to confirm their attendance. However, this method is very time consuming and is taxing on manpower, thus making it ineffective. Our idea to solve this problem would be to create a mobile application where reminders of appointments are sent and changes to the appointment can be made. Through this mobile application, the therapist is able to make use of slots cancelled by patients for other purposes, for example, arranging for a walk in patient. This will help to increase productivity without additional manpower or time involved as well as reduce wastage of slots available.

The technology partner has yet to be confirmed. 

[Team 133] Ventriculoperitoneal (VP)/ lumboperitoneal (LP) Shunt Setting Mobile Application

A ventriculoperitoneal (VP) or a lumboperitoneal (LP) shunt insertion is a common procedure performed in Neurosurgical patients with hydrocephalus. Many patients with VP/ LP shunt who are ambulant will return to society and resume their occupation as before. Patients will be issued with a shunt identification (ID) card upon discharge from the hospital. However, there is currently no system or database in place in the Neurosurgery department of Singapore General Hospital to keep track of patients’ VP or LP shunt settings. The proposal of this mobile application seeks to facilitate the recording of VP and LP shunt settings for the patients. End results will be an increase in awareness of patients’ individual shunt settings for patients and family members. Healthcare professionals will in turn have a reliable database of patient’s shunt settings, thus improving patient safety.

The technology partner has yet to be confirmed.

[Team 135] The Journey App: Supporting Patients to Return to Life

The success of healthcare is reflected in the patient’s ability to return to their daily lives as soon as possible after sustaining an injury or illness. However, being medically fit does not mean that patients are able to return to their previous responsibilities and life roles. Some patients do not follow through and pursue the recommended rehabilitation goals. Research showed that 40% of patients did not adhere to therapy recommendations and 13-20% of outpatient appointments were not attended. Delays in achieving independence in daily activities and returning to life roles result in increase in costs to the patient and society. Therapists have reported challenges in maximizing patient engagement in therapy. Sixty-eight percent of therapists surveyed reported that patients were resistant to engagement in therapy.11 In another study, 43% of patients had occasional to poor engagement in rehabilitation due to lack of effort, not completing therapy activities or refusal to participate. Social support, especially the emotional aspect of social support, was found to be a positive factor for motivation in rehabilitation and a predictor of better mental health outcomes. Interestingly, even the perceived availability of social support can mediate negative emotions and encourages positive behavior. Simulated presence therapy (i.e. watching or listening to a recording of a familiar person) was helpful in reducing negative emotions and behavior of patients with dementia. We propose the development of a novel game app that aims to harness social and emotional support as a motivator to address social isolation. In addition, the app can be a platform for tracking of patient’s progress by healthcare professionals and concerned loved ones. The game app should incorporate social support as a primary motivator to reward health-specific achievements. The app can track the patient’s journey from the time of admission and to community reintegration.

This team is working with Imaginary SRL to develop the solution. Imaginary’s products and services engage, motivate and empower users to meet the 21st century real world challenges faced by business and society in today’s competitive environment. 

[Team 138] Bed2FiD

Inertia monitoring units (IMU) are being increasingly used in research on hospitalised patients to measure the amount of ambulatory activity and also as a means of promoting self-directed walking to prevent deconditioning. Commonly used IMUs in stroke research are the activPAL, ActiGraph GT3X+ and the StepWatch. Although these devices have been validated in the stroke population, they have not been translated into routine clinical practice. This is because the devices require additional processes to put the device on/off and time/expertise to download data. Other wearable devices such as Fitbit may be useful in the healthy population, but they do not have appropriate algorthims to accurately measure ambulatory activity in people who walk slowly, with an asymmetrical gait pattern or with a walking aid. In addition, these fitness trackers require the use of fitness apps on smartphones, which limits its use to people who own smartphones. Thus, there is a for need for a clinically feasible and wearable IMUs that not only measures activity profiles but also has the capacity for measuring walking parameters such as speed. This system would allow clinicians to gain access to previously unavailable data pertaining to the activity levels of stroke survivors in rehabilitation. This will enhance the clinician’s evaluation of the patient’s progress and level of activity in rehabilitation, allowing customized rehabilitation programmes to be tailored for each patient. We propose the Bed2FiD activity system that taps on existing technologies and processes to measure and wirelessly transmit the information to both the clinician and patient.

 

This team is working with Aerspace Technology. This company specialises in motion analytics.

[Team 139] Helping to Walk Better Again, Walking the Walk

Walking is something we take for granted until we lose the ability to walk properly. We complain about walking to the bus stop or walking from A to B. That is until we get afflicted with a condition that impairs our walking, then we realise how great it is to walk with our feet. Gait retraining is common in rehabilitation. Currently, gait training is supervised within the physical therapy gym with cueing or feedback from the therapists. The patient may get auditory feedback from the therapist or some visual from coloured cones, lines or blocks placed alone the walkway. Some use mirrors to let them see themselves. One problem with this is that the patient doesn’t get a more engaging or interactive feedback. Are they bending or straightening their knees enough? Are they landing on their heels or toes first? Are they putting equal weight on the leg? Are they taking a proper step length? Another problem for the patient also is that that re-training is only limited to their time with the therapist and when they go home, their own practice of gait retraining is not monitored nor do they receive corrective feedback. Won’t it be great if there is a device wearable, which can measure parameters of the patients gait and give feedback be it visual or auditory to the patients on how they are doing, and how to improve it. If our fitness enthusiast and athletes can use wearable technology to help improve themselves, improve their training, improve their outcomes, why not our patients who actually may need it even more? Can we not have a dedicated wearable technology to help our patients? Therefore, we propose a system where a patient can wear an augmented reality glasses and look down and see visual cues on the ground where to place their feet.

The technology partner has yet to be confirmed.

[Team 140] Individualized Apps to Provide Psychological Treatment of Chronic Pain for Chronic Pain Patients

There is insufficient participation by chronic pain patients in appropriate psychological interventions for chronic pain management which has evidence to improve function, emotional well-being and pain control. There are many obstacles to persons with chronic pain receiving psychological interventions. Regular hospital and clinic based treatment sessions are time and labour intensive as well as costly. Existing Mobile Apps on psychological interventions for chronic pain are not individualised or monitored by healthcare professionals. Hence, reviews have not shown benefit. We propose the use of Individualised Psychological interventions using Web Based Mobile Apps with healthcare professional input and monitoring of treatment outcomes.

The technology partner has yet to be confirmed.

[Team 142] Breaking out of the Box and Helping Patients Move Again

The ultimate aim of rehabilitation is to facilitate neural recovery via neuro-plasticity. Once such approach to use visual imagery, which we believe can help promote neuro-plasticity. One way of making this happen is with mirror box therapy. Mirror box therapy is a form of therapy that been widely used for rehab especially for stroke patients. The concept behind mirror therapy is that visual motor imagery can stimulate the brain through the patient observing his or her own reflection of set of movement from unaffected side “to trick our brain” for thinking that the affected weaker side is moving. A mirror is placed at 45 degrees, and hiding the paralytic hand. It reflects the image of the sound hand seen over where the paralytic hand is. The patient looks down and sees the ‘image’ of his or her affected hand moving again and this helps to strengthen the visual imagery. Traditionally, it has been limited to upper limb and hand functions only. A problem that has been faced by patients is setting up a mirror box therapy system at home due to the size of the box and its limitations of types and range of ‘’movement’ permitted. This is because the relatively small size of the mirror box restricts the types of movement available. Another major concern is the duration time of repetition they need to perform and further challenging tasks upgrades they need to do. Also, it’s difficult for the therapist to monitor and track the set of movements or activities during the sessions as well as having it done at home. The patient may also not be as engaged with the therapy as the present of the mirror and the box may make it difficult to really imagine or make believe that they are making the movements with their hemi-parietic limb. The stationary nature of the therapy can also contribute to boredom and weaken the effectiveness of the treatment. We believe that the concept for Mirror box therapy can be strengthen, improved and enhanced by using current technology either in Virtual Reality/ Augmented Reality to provide visual stimuli for the brain to interpret it as virtually moving hand in the screen of the affected side to trick the brain and thus making the brain believe that the affected hand can move and able to perform his daily activity. The scope of therapeutic activates can be expanded and even extended to the legs as well. The Augmented Reality can make it even more realistic, games can be incorporated, for example involving both hands like throwing the ball, canoe paddling racing etc. All this making it more fun and engaging which we believe will strongly enhance the neuro-plasticity effect. With adequate software, we can also track and monitor the patient’s progress and also check the frequency of practice the patient does at home as well as helping them get it right.

The technology partner has yet to be confirmed.

[Team 143] Nasogastric Tube with pH Testing Indicator

To maintain nutritional intake for patients who are unable to take food orally, milk is fed through a tube with its distal end passing through the nose into the gastric. This is known as Nasogastric Tube (NGT) feeding. There have been unfortunate events when misplaced NGT caused serious patient harm, even death, when feeds wrongfully enter the respiratory tract or duodenum instead of into the gastric. Therefore, ensuring right tube placement before each feeding is paramount. The most common practice is to test the pH of the gastric juice that is manually aspirated from the NGT before each feeding (Ritin F et al., 2010). A value of less than 5 indicates that it is in the gastric region and feeding is safe to proceed, while a value more than 5 signifies that it is not in the right region. Sometimes, there are not enough gastric juices to aspirate and patients are turned to the left and/ or advancing the tube by 10cm before aspirating is attempted again after 15 minutes. If it is still unable to obtain an aspiration, a Chest X-ray (CXR) is done (MOH, 2010). CXR is the recommended way to ensure correct placement and is done post-insertion and when it is unable to obtain an aspiration prior to feeding. However, even if a CXR is done, wrong interpretation of it can also lead to dire consequences of feeding into a misplaced NGT (Eveleigh M et al, 2011). We are therefore proposing for a nasogastric tube with a distal end that can detect pH. The reading is displayed on the external end, near the feeding port to indicate right placement.

This team is working with i3 Precision on a possible solution. I3 Precision is a medical technology company that evolved from a joint collaboration between I3 Precision founders and Advanced Digital Science Centre in 2011. The initiative came about when the I3 Precision founders realise that there is strong market demand for products that will improve safety and traceability in medication management.

[Team 145] Parkinson’s Symptoms Monitoring Mobile Application

Despite medical and surgical advances in the management of PD, physical and cognitive disabilities persist, increasing as the disease progresses. The lifetime cost of PD in Singapore was shown to be more than SGD 60,000 per patient. This was largely contributed by increasing disability, hospitalization, and nursing home care. Motor dysfunctions such as reduced walking speed and balance, gait freezing, and rigidity may lead to disastrous consequences such as falls and hip fractures. Speech and swallowing changes may result in difficulties communicating, and aspiration pneumonia. Non-motor dysfunctions such as sleep disturbances, cognitive and memory problems, anxiety, and apathy also contribute to disability. One common goal of management is to minimize impairments and maintain functional independence, to optimize quality of life and reduce burden of care. However, clinicians are limited by the lack of diagnostic markers to quantify pathologic changes in brain structures. They therefore rely on clinical assessments, such as physical performance measures, to track response to medications and disease progression. To address the above gaps, a quantitative method to record PD symptoms is greatly needed. The aim is to provide early diagnosis and personalized treatments for PD. In 2020, the number of smartphone users in Singapore is estimated to reach 4.7 million. Our team aims to explore the use of a smartphone application to monitor PD motor and non-motor symptoms, and guide clinicians in optimizing treatments.

This team is working with NTU-UBC Research Centre of Excellence in Active Living for the Elderly (LILY) for a possible solution. The Joint NTU-UBC Research Centre of Excellence in Active Living for the Elderly (LILY) is a world-class research centre focused in the design of computing technologies that help the elderly enjoy an active and independent lifestyle. The LILY centre was set up in August 2012 with support from the Interactive Digital Media Programme Office (IDMPO), National Research Foundation (NRF), Nanyang Technological University (NTU) and The University of British Columbia (UBC).

[Team 148] Thera-tainment

When a person falls sick and is admitted to the hospital, the doctor would administer the best possible treatment to help the patient recover quickly. When patients’ medical condition becomes stable, the doctor would refer them to a therapist for rehabilitation. However, during patients’ stay in the hospital to undergo a rehabilitation program, they would usually spend 1-2 hours a day for therapy, and majority of the remaining time would be unproductive as they would be idling in bed. Some patients with special medical conditions are restrained in an isolation room with very limited contact to other people. This seclusion makes their participation in rehabilitation very limited as it reduces their much needed social interaction with others. These patients are negatively impacted in their journey to recovery thereby affecting their well-being with higher incidences of depression. In order to address the stated problems, we have devised an innovative solution that would ensure that such patients are self-reliant while focusing on their rehabilitation goals. This solution revolves around the concept of 3D imagery and first-person interactive activities to enable patients to immerse in a digital therapeutic experience. Our ground-breaking solution is essentially a device that could be used by patients while lying down, sitting up or standing upright. This device would comprise of configurable exercises and games related to therapy which could be easily customized by the patient’s therapist. It would project a 3D image of a game or exercise with a motion sensor to detect the participant’s movement. The participant will be interacting with the character and theme of the game or activity as first person as opposed to a 2D experience which many older patients find it difficult to comprehend and relate to. There will be virtual room for patients to play the chosen games and interact with each other or their family members and friends. Patients’ therapist can track their progress through the device and modify the game accordingly based on different levels of difficulty and stages of recovery. 

This team is working with VidSocial for a possible solution. They augment new video and existing video with amazing new levels of interactive, added content that responds to the viewer. This can range from simple added pop-up visuals and text, to embedded video-in-video, live feeds and full live 3D multiplayer game assets. All inside video to create a completely new level of augmented viewer engagement whether for a great promo video, a brand campaign, interactive sales or training demo, or content on music, the outdoors; the content types and ways in which our video technology could add value is almost limitless.

[Team 150] Using Smartphone Automated Electrical Muscle Stimulation for Early Prevention of Acute Muscle Wasting in Critically Ill Intensive Care Patients

Critically ill patients admitted to the Intensive Care Units suffer acute muscle wasting in major muscle groups which compromises their physical functional recovery and early return to walking. These group of very ill patients suffer significant muscle mass loss within 3-4 days of ICU admission due to mandatory sedation and immobilization as a result. Several researches performed on critically ill patients have shown that Electrical Muscle Stimulation (EMS) can prevent or decelerate the muscle mass loss and it has been reported to also improve tissue circulation and however physiotherapists can only perform EMS in addition to simple passive exercises on these group of patients depending on permissible medical condition which may not be early intervention i.e. more than one week of no muscle movement or activation. In addition, muscle cell proteolysis or apoptosis i.e. self-destruction is known to occur due to inflammatory nature of critical illness. This can greatly compromise muscle bulk, strength and eventually physical function impacting activities of daily living such as walking. When patients are deemed fit start physical rehabilitation, the EMS is normally provided only once or twice a day due to limited physiotherapy time with patient who also requires other medical attention. Although early mobilization is encouraged, critically ill bedridden patients may be unable to initiate any active movement for a minimum period of 7 days and up to 2-3 months on an average depending on the severity of the disease. Even if initiated, early mobilization is mostly sporadic and is greatly limited i.e. once a week by various factors such as presence and participation of a multidisciplinary team, patient dependence on mechanical ventilation for oxygen support and other attachments which compromise easily mobility of the patient. An average normal adult uses major muscle groups constantly either isometrically, concentrically or eccentrically for daily activities from sitting, standing to walking. We believe that by initiating pre-programmed bedside EMG stimulators through a novel phone application which can be safely operated by nurses and therapists on major muscle groups such as the quadriceps, tibialis anterior, biceps, triceps and finger flexors and extensors, we would be able to significantly reduce muscle mass loss in critically ill patients. Automated muscle contractions of at least 6 to 8 sessions of muscle contractions can be delivered safely to ensure patient received some muscle stimulation in major muscle groups through their ICU day and stay until which mobilization is deemed fit. With maintained muscle activity even through bedrest we would be able to decelerate the muscle mass loss and maintain sufficient muscle strength required for early sitting and walking following ICU stay which would translate to early ICU and hospital discharge, early return to premorbid physical function and improved quality of life.

This team is working with PowerDot to develop their solution. Powerdot muscle stimulator is the solution for any active person who is looking for stronger results and better recovery for their muscles.

[Team 153] Educational Applications for Patients on Chemotherapy Treatment

One of the ever taunting challenges working in a cancer treatment unit is providing education to patients and their significant others. Besides dealing with the emotional millstone, patient and their significant others will potentially experience feeling of “information overload” from the education provided by healthcare professionals throughout their treatment trajectory. Studies had shown only 7% of spoken words are received by the receivers during communication session hence providing information to patients and their significant others through visual methods are of paramount importance. In the cancer treatment unit, patients and significant others received information regarding cancer, chemotherapy and its related side effects, treatment trajectory and follow up care which many a time, we witness information loss by the receivers. Visual aids are available in handouts/booklet whereby it would be given to patients and their significant others; however, the rate of misplacing the handouts/booklet is high. In managing their side effects, patients and caregivers will be given a telephone triage number whereby they would need to call in to speak to the nurse, narrate the symptoms to get advise/follow up. When there is a need to arrange for appointment or follow up, series of calls would need to be made to ensure that patients and caregivers had the information on hand to follow up with their appointments. Patients and caregivers will need to transcribe the said conversation onto their phone or a piece of paper leading to possible transcription errors. In order to ensure patients and their significant others had adequate information for them to be confident participating in self-care effectively, our team had brainstormed for ideas to enhance education components. Recognizing that our population is getting more IT savvy, gearing our thoughts and solutions towards Information Technology (IT) are buttoned down. With the required information available as an application can allow patients and their significant others to download the information at their convenient into their smart phones, tablets or computers. With the information readily available at their fingertips, users could search for information that they required at any time of the day.

The technology partner has yet to be confirmed.

[Team 156] Redesigning of Commode

The primary purpose of the commode is to provide an alternative to weak and debilitated patients who are unable to get to the toilet or sit on a toilet bowl. In an oncology setting, this is a common scenario as the patients are often faced with a multitude of medical problems that predisposed them to impaired physical capacity, sensory or neurologic deficits, gait instability, urinary and bowel incontinence and fatigue. As a result, patients often experience loss of independence in a range of domains that include personal care such as elimination needs. During this period, bedside commode is an effective alternative for patients as it is less stressful and safe than using the bedpan. The current commode is not height adjustable which can be a potential for fall during transfer from bed or chair. There is also an increased occupational hazard for the staff when handling patients during transfer. Also, the seats and backrest are not comfortable for the weak and emaciated cancer patients, thereby predisposing them to potential skin injury during transfer or skin excoriation when seated for long. Lastly and equally pertinent, by redesigning the commode, the department will be able to maximise its limited resource utilisation as less storage space is required. Our team suggest to redesign the existing commode with under seat pan to be more user-friendly, ergonomic and to facilitate convenient compact storage.

The technology partner has yet to be confirmed.

[Team 158] Under the Sea for Anaesthesia!

Children having a phobia of new environment. This is especially true when they come to the hospital or the operation theatre. Often, due to the strange environment that they are exposed to, they become extremely afraid, cry incessantly and are unable to cooperate for anaesthesia. We would like to ease the induction of anaesthesia for children coming for anaesthesia in the operation theatre. Often the sights of the machines and operation lights is enough to induce severe anxiety. In addition, children are placed under anaesthesia using inhaled medication to avoid the need for placement of intravenous lines. We would like to develop a game using Virtual Reality technology that simulates diving in the sea. This would provide a distraction to patients when they enter the operation theatre. In order to facilitate interaction with the VR underwater environment, we would like the patients to have a diving facemask where they can inhale and exhale from. This mask would be connected to a flow meter. With a good air flow reading from the mask, this would create interactions with the sea environment and appearance of various cute sea creatures like fishes, octopus and starfishes. Unknown to the patient, the breathing movement of the patient while playing in the VR environment would induce anaesthesia as the mask can be connected to the anaesthesia delivery machine. We hope to locate a support partner that is able create a VR under the sea environment. The VR headset should also be able to fit children from the age of 2 to 10 years of age. At the same time we would need to facilitate interaction with the environment with use of a flow meter. 

This team is working with Cafiend & IgniteVR to develope a solution. Cafiend serves to provide organisations with an integrated suite of marketing, advertising and design services. Ignite VR is the first virtual reality arcade in Singapore. Together, they will work with the team to create the solution they are looking for.

[Team 159] Building a Robust System for Tracking of Inventory and Movement of Dental Instruments

In dentistry, instruments such as scaling tip, hand pieces, burs are commonly used daily for the treatments and they are many different types of instruments needed for the various treatments. Due to the high volume of cases seen in National Dental Centre Singapore (NDCS), the turnaround time for the instruments has to be fast for the Central Sterile Supplies Department (CSSD). The issues are made complicated when there are more than 180 different types of dental instruments for 7 different specialties (and this spreads across 5 levels of Specialist Outpatient Clinic, SOC) with various permutations and CSSD has to reprocess 8000 packets of dental instruments per day. Very often, there is feedback from the clinic executive that there is a shortage of dental instruments and the demand cannot be met. In addition, when the dirty dental instruments are sent to CSSD for sterilization, there are times when the CSSD staff noticed that the number of dental instruments do not tally with the number of clean dental instruments that was delivered to the various levels of SOC. Currently, there is not a robust system to track the number of dental instruments for inventory purpose and the movement of clean and dirty dental instruments to and fro from CSSD.

The technology partner has yet to be confirmed.

[Team 160] MyCare Journey App

Despite efforts by healthcare professionals to gainfully engage patients during every hospital visits, they are simply too many permutations (e.g. medical history, lab and diagnostics results, medical appointments, medications, lifestyles, social issues, etc.) for the limited hospital resources to revisit each of these factors holistically. Without the full picture, the care delivery will be perceived as silos, instead of being streamlined and patient-centered. Beyond the physical care site, healthcare professionals have very limited channels to engage their patients. These may result in appointment no-show, medication non-adherence, lack of lifestyle change and even condition deterioration. Without any interventions, these patients may eventually present themselves into the emergency department again. Caregivers may also feel inadequate to take care of patients with complex care needs. The absence of proper support will inevitably increase their care burden and stress level. At the extreme, they may unwillingly admit their loved ones into one of the care sites, which they perceive as being able to provide a better level of care. By design, healthcare is not optimized for patients across care sites because of the heterogeneous array of healthcare providers. Patients themselves are also not in the best position to manage their own care plan because of the lack of structured patient journey tool. In order to empower patients with a structured patient journey tool, it is proposed to design and develop a mobile application called “MyCare Journey” to guide them across different care sites. With the MyCare Journey, patients will be able to maintain and share their care plan across different care sites. They will also be able to communicate remotely with their healthcare professionals and vice-versa. Lastly, their primary caregiver can receive support by sharing the care activity to another caregiver.

The technology partner has yet to be confirmed.

[Team 161] Android Application For Emergency Bed Booking System In Hospital

The referral of traumatic brain injury patients to a tertiary hospital is done because of lack of general surgeons who have experience and are trained in the management of Traumatic Brain Injury (TBI) or lack of neurologist trained in the management of neurotraumatology. Multiple organ trauma patients also need to be referred to hospitals that can manage polytrauma. The Hospital Universiti Sains Malaysia is the only tertiary center that provides specialized clinical neurosciences care covering a catchment area of nearly four million people (Kelantan,Terengganu,Kedah). When the patient arrives from a primary care or secondary care hospital to Hospital USM, there is a backlog of patients require different level of care

The technology partner has yet to be confirmed.