Sequence

Summary

It is extremely vital for patients to follow a continuous regimen of daily doses of medications, so managing one’s treatment can be an extremely difficult task. Sometimes even missing a single dose can substantially worsen health conditions. Having a full-time assistant in this situation would ease the challenge, however, this is not always possible considering many different obstacles. That is why ‘Sequence’ represents a worthy product for the usage. We used an engineering method of testing and made correction works according to them.

‘Sequence’ represents great perspectives since it is an innovative project. What makes it distinguishable? First, it is able to connect a patient with a caregiver from anywhere on the planet. Second, it is highly convenient and simple to use, so there are no extra movements needed because it works autonomously. Third, the pillbox is cheap, which makes the device available for most of the people in a comparison with other products. We would totally describe it as simple, convenient and effective. As a result, we ended up having the relevant answer to our initial question, by having an appropriate solution as 'Sequence'. 

Our team looks forward to the enhancement of the project, due to its high relevance in the modern community. Therefore, we aim the following goals:

1) Extend the mobile application with machine learning algorithms

2) Integrate the project with fitness bracelets, to send more input a patients condition

3) Integrate the pillbox with pharmaceutical pills packaging to collaborate with companies

 

 

 

 

Question / Proposal

What is a chronic disease and how can we deal with it?

A chronic disease is a condition you can control with treatment for your entire life. Asthma, diabetes, and depression are common examples. Often, they don't have an exact cure, but a patient can live with them and manage their symptoms, therefore, having a really strong focus on following the treatment is extremely vital.

Chronic diseases have long been eradicated from the world's industrialized nations
but continue to take a terrible toll in a few poor, rural regions of Asia and Africa.
It's not that new medications are needed - medical science long ago figured out how to tackle the diseases. 

'The problem is, how do you get people to take this complex regimen' 

says Manish Bhardwaj, a doctoral student in the Department of Electrical Engineering and Computer Science who works in the Microsystems Technology Laboratories. Missing even a single dose can substantially deprave condition of a patient.

Thus, we are now interested in identifying the current methods of managing medications, but we suppose they have significant drawbacks. We look forward to solving this problem by the caregiver involvement so that a patient would not face a treatment alone and to creating a smart technology that will make sense. 

We hope that our future experiment would show us how our idea works out in real-life conditions. Therefore, the results of research work should clarify the needs and help us personalize the solution.

 

Research

Medication non-compliance in the US causes approximately 30%-50% of medical treatment failures that lead in approximately 125,000 deaths annually and has an estimated direct cost of $300 billion. Medical research during the past few decades has created tremendous amounts of medication treatments, but unfortunately, low adherence can undermine the effectiveness of care at many steps in the process1-4.

Several ethical issues must be addressed when considering and attempting to improve patient adherence.5,6 First, the clinical diagnosis must be correctly identified. Second, the treatment being prescribed must be of known efficacy for this diagnosis and appropriate for the patient’s circumstances. Third, the patient’s right to refuse treatment must be understood and respected7.

Methods of raising the adherence summarised in Boxes 1,2 and 3.12

Box1 12


Practical methods (apply to all patients)


1)Asking the patient                                                                     2)Treatment response                                                                 3)Attendance at appointments

If applicable
Drug levels
Pharmacy refills Medication event monitors

*Based on Stephenson et al.3

 

Box2 12

1)Counseling about the importance of adherence
2)Written instructions about taking

medicines
Reminder packaging (eg, calendar packs, dosettes)

*Based on references8-11.

 

Box 3 12

Combinations of

1)Instruction and instructional materials
2)Simplifying the regimen (eg, less frequent dosing, controlled release dosage forms)                                                                         3)Counseling about the regimen
4)Support group sessions
5)Reminders (manual and computer) for medications and appointments
6)Cuing medications to daily events
7)Reinforcement and rewards (eg, explicitly acknowledging the patient’s efforts to adhere)
8)Self-monitoring with regular physician review and reinforcement 9)Involving family members and significant others

*Based on McDonald et al.8

Thus, a combination of keeping the regimen as simple as it is possible and using different types of reminders, involving family members and monitoring adherence considered to be the most practical ways of helping patients to follow their complex regimen. 

By analyzing information about ways of helping patients raise the adherence, we made sure that our idea in involving close people for help is sufficiently relevant. Furthermore, since the caregiver will actively immerse in this process, we need to have a strong focus on monitoring a patient's actions, however, caregivers are not always able to provide the hands-on assistance. While living at a distance or having an extremely hectic schedule can complicate the process. Being a caregiver for someone with serious condition requires flexibility, patience, along with enormous time resources. As the abilities of the person with a chronical disease change and functioning independently becomes more difficult, responsibility rises up. Furthermore, patients can have a difficult time accepting help, mistakenly believing that their voice is not respected. This can lead to irritability, anger, exhaustion, social withdrawal, anxiety, depression and other problems for both the patient and a caregiver.

That is why we've come to a decision to provide a monitoring process in distance, while both sides can collaborate to help each other. In this case, our research helped us to come up with making pillbox, but not an ordinary one. This clearly represents how medication non-compliance is widely spread and requires a relevant solution. No one should face a disease alone.

 

 

 

 

 

 

 

 

Method / Testing and Redesign

 IDEATION

We decided to come up with a "box" model, to make the open/close activity easier.

DESIGN:

To plan the way it works, we made some sketches. The device itself will be designed in the shape of a pillbox, that contains several compartments. It is equipped to remind a patient when to take pills, using frequent notifications. The device will also have a buzzer inside, while every compartment comes with an appropriate LED above. Pillbox would light up at the right place and play a melody when the time comes. We decided that pillbox will wait for the actions of a patient and will watch him taking pills, missing them or taking the wrong dose. Meanwhile, the caregiver would use the mobile app, that will provide the following functions:

1) set the time for the pillbox reminder

2) monitor the patient’s actions (taken/missed/the wrong dose taken)

3) control the patient’s regimen

Subsequently, we started searching for ways for possibly connecting the hardware and software. Finally, we ended up finding a Firebase console a convenient use for our project. The constant variable will be the time or a schedule according to which a patient takes pills, and the dependent variable is the LED status.

That is an algoritm, how our device works

 

IMPLEMENTATION:

Hardware:

To implement the design in real life, we had to search for ways of connecting the database. We needed relevant libraries, such as Firebase Master for Arduino IDE to fetch information from database frequently.

The initial prototype looked like this:

We made a pillbox by just cutting a plastic pencil case and gluing it. Here we had a button for a patient to press after he takes a reminder, however, it represented several problems, as long as it depends on the humanitarian factor.

Afterwards, we made another one using a laser printer, much more convenient for use. We took previous conclusions into consideration and used 2 sensors: motion and weight sensor for automation.

  

Software:

For software, we chose Java programming language and created an app in Android Studio. We connected the app with Firebase to made a user-friendly design.

   

 

We worked in our school laboratory, using a laser printer and 3D printer.

 

TESTING:

We used an engineering method of testing. Attending different hackathon was a great way to test the idea with professionals. First, we attended the IoT hackathon held by Microsoft and Chevron in the last days of September and presented the initial prototype of a pillbox, where we were given a money certificate for creating the newer version.

Using the money we won, the second version of a pillbox was created. A month later, we presented it to the vice minister of healthcare in Kazakhstan at the Youth4Health hackathon held by UNICEF and the ministry of healthcare, who called it 'an innovative project, that can make sense in digitalization of medicine in KZ'. Thus, we have rewarded a money certificate for creating an industrial prototype, on which we are working on right now with UNICEF laboratory in Almaty.

     

TESTING VIDEO

SAFETY MEASUREMENTS

 

 

Results

                                                

     After 3 weeks of hard work, we name our project "Sequence". It is a smart pillbox controlled by an app. 

     A caregiver opens an app and set a time when a patient should take pills. He can choose the duration of repeating of reminder. If time reached at exactly time that caregiver sent, the data on a database, exactly LED_STATUS changes to 1(True), this signal immediately sends to a device. The app receives 2 type of notification. One of them, when the patient took a pill, the second one when the patient opens a slot and takes a medicine at a wrong time. 

     The app was written in Android studio IDE using java programming language. Java is an object-oriented structured language, which gives an opportunity to use various functions as a callback, add different libraries and make the user-friendly design.

      As a result, we made a pillbox which has 3 slots where caregiver or patient put medicine. Each of them is covered and has a small light ball on top to make a blinking signal when time to take medicine reaches. Also, a device has a hidden buzzer that makes a buzzing sound when the time is coming to take a pill. As a result, we made a convenient, accessible device for our grandparents. During patient takes a pill the motion sensors capture the action. If he takes the pill, the audio and visual signals turn off.

     The application receives a notification that the patient takes a pill. In case of not taking a medicine, the audio and visual signal will continue alerting. In addition, if the patient opens a cover of one slot not on time the buzzer will also make an alert sound. In that case, a caregiver receives different types of notifications to be on track with a patient's treatment.

      

    The hardware was made of an acrylate plastic. It is a good material for reshape a design and experiment different models with a laser printer. The core of the device is hidden where motion sensors detect the user's pill-taking process. One of the most comfortable features is working with WI-FI. Thus, distance is no longer a limit to check, worry or disturb your closes to know, if their taking course of treatment or not. 

      

Firebase database with our code gives opportunity to:

  1. Real-time Database changing; (To change the value of LED_STATUS)

  2. In-App Cloud-Messaging; (to send notifications)

  3. Firebase-Firestore to save duration and time; (Duration and timestamp)

During a result we made some analysis of our project:

Strengths:

     1. Work with Wifi and low to connect everywhere;

     2. Light and Simple to use;

     3. Cheaper and has only necessary functions;

Weaknesses:

    1. Not comfortable to take in a bag;

    2. Has small slots, and often reconnects to new WiFi slower;

Opportunities:

     1. New Design, for example, the jar with cover to travel;

     2. New functions, (display recommendations from doctors);

     3. SOS and emergency helper;

Threads:

     1. Problems with a budgetary material.

 

Conclusion

SUMMARY

A couple of months ago, we immersed ourselves in directing our skills toward healthcare management issues. We found out that medication non-compliance is of a current interest and requires relevant solutions, thus created a 'Sequence' smart pillbox, which helps patients follow their regiment with a help of caregivers.

USABILITY

Testing this system at different hackathons, we got positive responses and advice from professionals. They commonly liked the device and referred to it as 'innovative and perspective project'. They mostly loved its usage simplicity, since it doesn't require extra efforts. This is largely because 'Sequence' works autonomously and relies on variable sensors.

LEARNINGS

During the working process, we came upon new ideas and implementations of a project. Thus, we found out that medication management is crucially important though it might be mistakenly believed to be inconsiderable. While creating a prototype and developing its features, we enormously enlarged our skills in IoT technologies and Arduino platforms with sensors. Furthermore, we took a header into project management and experimenting methods.

ENHANCEMENTS

Although the device works fine most of the time, it can be fooled by special tricks. We created a certain algorithm, that minimizes the possibility of outer intervention by making precise predictions of patient's actions, however, it still needs improvements. Also, we should use more developed and compact tools, to increase device portability.

FEATURES

‘Sequence’ represents great perspectives since it is an innovative project. What makes it distinguishable? First, it is able to connect a patient with a caregiver from anywhere on the planet. Second, it is highly convenient and simple to use, so there are no extra movements needed because it works autonomously. Third, the pillbox is cheap, which makes the device available for most of the people from the average class.

COST

Sequence costs approximately 30 USD, and here is a bill of materials:

NodeMCU ESP8266 board: $8.39 

Weight sensors: $5.69 * 3 = $17.07

Motion sensors: $1.69 * 3 = $5.07

FUTURE PLANS

Our team looks forward to the enhancement of the project, due to its high relevance in the modern community. Therefore, we aim the following goals:

1) Extend the mobile application with machine learning algorithms

2) Integrate the project with fitness bracelets, to send more input a patients condition

3) Integrate the pillbox with pharmaceutical pills packaging to collaborate with companies

Experimenting with a project helped us correct our mistakes, and make a product better. Seeing how our idea developed into a real solution in weeks of hard work empowers us to work more. To explore. To think. To create. It certainly filled our work with a social meaning and significance. We believe this is a vast new source of motivation for our future investigations.

 

 

 

 

About me

We are the team of girls from Kazakhstan, Almaty.

What we do is robotics. We met each other in a school lab in a previous year knowing barely anything about robot construction. Happily, thanks to our inexhaustible desire to succeed, we made it to the largest robotics competition on a planet called 'VEX Robotics World Championship' in Louisville, KY and got to the playoffs there. It was a plenty of hard work, worries, fear along with satisfaction, pride, and of course, a victory.

At PROFEST competition in Moscow, where got to the finals  

 

Dilnaz Kamalova, 15 y.o:

- "Once I stumbled across the robotics lab in our school, I got stuck. But to be honest, it took a lot from me to finally step into that room, because I felt nervous and 'not good enough'. However, not a single skill makes a person insufficient, unless he has a desire. That challenges and I like it. I adore the brilliant mind of Imambekov Adilet. My future plans are to study AI abroad."

Dana Yerlanova, 17 y.o:

- "I wrote a new resolution during 31 December. I never believe in Santa, but that night was changing for me. I shoot a video about goals and I swear to fulfill my life with programming, traveling, even launching an app. Luckily, all my goals were done! I read 14 books, one of them about creative and smart S.Jobs which motivated me. As a growing, I want to study the whole my life, but for 2 years I want to be spent at university 42."

 

Health & Safety

We worked on our project in the school engineering lab. It contains a lot of equipment starting from Arduino breadboard, ending with a 3D printer. Below we displayed guidelines that we followed in our school lab:

1. Follow instructions given by your teacher and ask permission to work on any equipment;

2. Transport all materials and equipment safely;

3. Eating or drinking are prohibited in the lab at any time;

4. Wear safety goggles to protect your eyes when printing on a laser printer;

5. Ask help or permission before working with a soldering iron;

6. Check wires integrity before plugging in;

7. Do not leave equipment plugged in and keep clean your working place;

     

            

 

Our mentor is our robotics teacher:

Inkarov Bekzat Amirtaiuly

Email: inkarov.b@gmail.com

Bibliography, references, and acknowledgements

Resources: 

1. Sackett DL, Snow JC. The magnitude of adherence and non-adherence. In: Haynes RB, Taylor DW, Sack- ett DL, eds. Adherence in Health Care. Baltimore, Md: Johns Hopkins University Press; 1979:11-22.

2. Haynes RB. Improving patient adherence: state of the art, with a special focus on medication taking for cardiovascular disorders. In: Burke LE, Okene IS, eds. Patient Compliance in Health Care Research: Ameri- can Heart Association Monograph Series. Armonk, NY: Futura Publishing Co; 2001:3-21.

3. Stephenson BJ, Rowe BH, Haynes RB, et al. Is this patient taking the treatment as prescribed? JAMA.1993;269:2779-2781.

4. Gilbert JR, Evans CE, Haynes RB, Tugwell P. Predicting compliance with a regimen of digoxin therapy in family practice. CMAJ. 1980;123:119-122.

5. Johnson AR. Ethical issues in compliance. In: Haynes RB, Taylor DW, Sackett DL, eds. Compliance in Health Care. Baltimore, Md: Johns Hopkins University Press; 1979:113-120.

6. Levine RJ. Monitoring for adherence: ethical considerations. Am J Respir Crit Care Med. 1994;149: 287-288.

7. Haynes RB. Determinants of compliance and non- compliance. In: Haynes RB, Taylor DW, Sackett DL, eds. Compliance in Health Care. Baltimore, Md: Johns Hopkins University Press; 1979:49-62.

8. McDonald HP, Garg AX, Haynes RB. Interventions to enhance patient adherence to medication prescriptions: scientific review. JAMA. 2002;288:2868-2879.9. Sharpe TR, Mikeal RL. Patient compliance with antibiotic regimens. Am J Hosp Pharm. 1974;31:479-484.10. Linkewich JA, Catalano RB, Flack HL. The effect of packaging and instruction on outpatient compliance with medication regimens. Drug Intell Clin Pharm.1974;8:10-15.

9. Sharpe TR, Mikeal RL. Patient compliance with antibiotic regimens. Am J Hosp Pharm. 1974;31:479-484.10. Linkewich JA, Catalano RB, Flack HL. The effect of packaging and instruction on outpatient compliance with medication regimens. Drug Intell Clin Pharm.1974;8:10-15.

11. Dickey FF, Mattar ME, Chudzik GM. Pharmacist counseling increases drug compliance. Hospitals. 1975; 49:85-88.

12. R. Brian Haynes, MD, PhD Heather P. McDonald, BSc Amit X. Garg, MD, MA, Helping Patients Follow Prescribed Treatment. 2002; 1-4.

Sites:

Firebase

 

There were several people who provided a lot of support for our project with their help:

1) Inkarov Bekzat, our mentor, who helped to create a hardware part of a project using the laser printer and AutoCAD.

2) Eric Mayer, the general US consulate in Kazakhstan, who gave us a certificate for $500 to buy an equipment, such as Arduino platforms, sensors, batteries, and materials.

3) Ibrasheva Raushan, the UNICEF Partnership Director in Kazakhstan, who provided us a co-working space in the IITU  (International Informational Technologies University) in Almaty.

4) Saduakassova Dinara, the goodwill ambassador of UNICEF, and Abishev Olzhas, the vice minister of healthcare in Kazakhstan, who gifted us the certificate for 600 000 tenges, dedicated for the further implementation of a pillbox.

Our school (Nazarbayev Intellectual School of physics and mathematics of physics and mathematics) provided the lab and equipment that we used: Arduino developer packs, 3D and laser printers. We asked for our mentor's help to create an appropriate design to implement it for more convenient use than we had it initially on our prototype. Therefore, we learned to accompany the design of a pillbox with the details inside to make it as small and portable as possible.