Monitoring of catabolic markers

Abstract

To improve health and care through monitoring health markers.SOLUTION: In one example, a method includes: measuring repeatedly at different times a quantity of a biochemical marker in a patient; storing the measurements in a log as entries associated with the patient; analyzing the stored measurements by comparing the quantity of the marker across the plurality of log entries; and determining an illness condition when a recent entry is different from previous log entries, for example when the recent entry is different by more than a threshold or when a baseline level or regular pattern is established from the multiple stored measurements and the recent entry is a change from the baseline by more than a threshold. If a deviation is determined, then an alert condition regarding the patient is determined.SELECTED DRAWING: Figure 1

Description

[Technical Field]

[0001] This invention relates to the monitoring of catabolic markers. [Background technology]

[0002] Modern medicine takes two main approaches to a patient's health. The first approach begins when the patient notices symptoms. The patient reports their symptoms to a doctor or other clinician, who then analyzes the patient by looking for signs and asking about additional symptoms to make a diagnosis. The diagnosis then leads to specific treatment. This approach is effective when there are early, obvious symptoms. In cases of mild symptoms or symptoms that only appear later in the onset of the disease, it may be too late for the patient to report the symptoms in order to provide effective treatment.

[0003] The second approach involves monitoring a condition or sign in the body and administering treatment to correct the monitored condition. This condition is usually not a disease or injury, but is considered related to a disease or injury for therapeutic purposes. A common example is monitoring the presence of various cholesterol levels in the blood. Medication or dietary changes may be prescribed to lower the concentration of a particular cholesterol. This concentration is associated with heart failure, and many patients have extended their lifespans with cholesterol-lowering drugs. However, some patients with low cholesterol die from heart failure, while some patients with high cholesterol do not. While controlling cholesterol levels or other bodily conditions can improve the health of many patients and prevent emergencies, controlling cholesterol levels does not address the usefulness of disease detection or emergency treatment.

[0004] Both of these approaches require early detection and rapid access to treatment. Today, many people have easy and quick access to medical professionals and treatment. At the same time, even if it is easy and quick to reach a doctor or clinic, it is not always clear when one should visit a doctor or clinic. Often, people arrive too late, after their illness or disease has become severe. Many people end up in hospital emergency rooms or emergency medical centers on weekends or at night because they did not consider their symptoms to be serious when free doctors or clinics were still open.

[0005] More than half of all hospital visits are unplanned, and the most expensive emergency room is the main source of revenue for hospitals. Many hospitalizations begin in the emergency room and then move to other parts of the hospital. Hospitals are also permitted to charge higher fees for emergency room visits than for planned admissions. Although hospitals' share of overall healthcare costs is decreasing, they still provide all aspects of intensive care due to their unique functions and increasing integration. In recent decades, there has been increasing pressure to reduce healthcare costs, especially hospital costs. If hospital costs are higher than clinic costs and emergency room visits are more expensive than planned admissions, resources can be saved by reducing emergency room visits.

[0006] This increased scrutiny of costs is explained as a shift from quantity to value. One cost-reduction effort involves alternative payment models that aim to reward healthcare providers for the value they provide to patients, rather than the intensity of treatment they receive. One aspect of this is that hospitals are held liable if a patient is readmitted shortly after being discharged.

[0007] Hospitals are reducing readmissions in various ways. One measure is to ensure that patients are discharged with the correct discharge instructions and prescriptions. Another measure is to assign a care coordinator who can help patients navigate post-acute care options and follow up for 30 days after discharge. A more expensive measure is to assign visiting nurses to visit patients early before readmission. By examining patients at home, problems can be addressed and readmission can be avoided. Another measure is to transfer patients to nursing facilities when problems arise, either directly or at home. Nursing facilities can intervene and resolve problems instead of the hospital. [Brief explanation of the drawing]

[0008] The present invention is illustrated in the accompanying drawings as an example, not an limitation, in which similar reference numerals refer to similar components. [Figure 1] Figure 1 is a simplified block diagram of a system for determining health status using a biochemical monitoring system according to an embodiment. [Figure 2] Figure 2 is a process flow diagram illustrating an example of the operation of the system shown in Figure 1. [Figure 3] Figure 3 is a messaging diagram for health analysis by a central server according to the embodiment. [Figure 4] Figure 4 is a messaging diagram for health analysis using a local terminal according to this embodiment. [Figure 5] Figure 5 is a diagram of a tabletop NMR measurement system according to an embodiment. [Figure 6] Figure 6 is a process flow diagram showing an example of the operation of the system in Figure 5. [Figure 7] Figure 7 is a diagram of a wearable measurement system according to an embodiment. [Figure 8] Figure 8A is a diagram of a portable measurement system according to an embodiment. Figure 8B is a magnified view of the sensor of the system in Figure 8A for measuring the earlobe. [Figure 9]Figure 9 is a diagram of an alternative portable measurement system according to the embodiment. [Figure 10] Figure 10 is a diagram of a fixed urea measurement system according to an embodiment. [Figure 11] Figure 11 is a block diagram of a computer system suitable for an embodiment. [Figure 12] Figure 12 is a diagram of the components of the system shown in Figure 7 according to an embodiment. [Figure 13] Figure 13 is a diagram of a Raman spectroscopy system according to an embodiment. [Figure 14] Figure 14 is a diagram of an alternative Raman spectroscopy system according to the embodiment. [Modes for carrying out the invention]

[0009] As described herein, biochemical signatures are used as early warning indicators to identify the onset of a wide range of diseases before they become acute. Early warnings can be used to schedule appointments and avoid emergency room visits. They can also be used to schedule treatment before the disease has progressed too far and it is too late. This impacts a market that accounts for 2% of the US Gross Domestic Product (GDP). Biochemical signatures can be tracked and monitored using conventional medical devices or specialized devices. Small, home-use devices can be used for continuous or frequent non-invasive monitoring. These devices may also have communication capabilities to connect people to healthcare professionals if signs of disease are present.

[0010] Hospital and emergency medical clinic healthcare is on the brink of collapse. Emergency medicine, one of the most painful entry points into the healthcare ecosystem, is also addressed herein. As described herein, signs of a patient's health are monitored frequently, and sometimes non-invasively, to determine when a patient's health is deteriorating. Such determinations enable patients and healthcare providers to be more than just reactive players in the fight against many forms of illness. Early detection and communication allow professionals such as physicians, clinicians, and other healthcare providers to get in touch and initiate treatment directly, using the right tools and immediate feedback. Many of the signatures monitored as described herein indicate many or all types of illness across the entire system of the body, rather than focusing on a single disease or the symptoms of a disease.

[0011] The methods and systems described herein are applicable to all those interested in risk stratification and early detection. One application is reducing hospital readmissions. This is an urgently needed area, and in recent times, a balance has been struck between good clinical practice, policies, and financial pressures. Hospitals can increase evaluation and payouts, improve patient outcomes, and treat more patients who need treatment by keeping patients out of the hospital when they don't need it. This is increasingly true in an aging and long-lived society.

[0012] Other applications include care management companies, insurance companies, and employers. All of these groups are interested in maintaining the health of patients and employees while keeping costs down. Similarly, nursing homes and other long-term care facilities want to avoid sending patients to hospitals. Everyone wants to determine when a patient needs treatment before it's too late. Detecting serious illnesses before symptoms become apparent can avoid emergency room admissions and instead allow for regular treatment.

[0013] As another new trend, the market is flooded with fitness monitors or trackers, smartwatches. These devices typically measure heart rate and overall movement of the wrist. Some of them can also measure other electrophysiological phenomena of the wrist or body. Such devices are useful for monitoring fitness training and activities during sleep, but they are for measuring exercise levels. They do not indicate illness. A fitness monitor does not provide a baseline of health against exercise, but rather a baseline of sedentary physical activity against physical activity during activity.

[0014] Another trend in monitoring is the use of highly targeted tests for specific diseases. It aims to determine whether a patient has recovered from a specific disease by repeating measurements. This type of monitoring requires specific intensive and frequent interventions that are prone to a lot of human error. This type of care management is a very manual and high-level proposition. Care coordinators or nurses diagnose individual patients in a non-scalable and costly way. The tools for diagnosis and alert are rudimentary.

[0015] In contrast, the methods and systems described herein enable a patient or a nearby healthcare provider to reliably monitor one or several conditions repeatedly in order to measure the overall health status. In some embodiments, different baselines can be individually set for each patient. Variations from this baseline can be used to trigger certain alerts or warnings.

[0016] Figure 1 is a simplified block diagram of a system for assessing overall health using a biochemical monitoring system. In this example, patient 102 has access to the biochemical monitoring system 104 to measure the values ​​of one or more specific biochemical markers. The monitor can be a fixed or portable device or a wearable device. The device may require the patient to perform specific actions, or the device may operate autonomously or automatically. For example, the device may require the patient to insert their finger into a scanning device and hold their finger there for a certain period of time. As another example, the device may be worn on the wrist or elsewhere, or attached to clothing, or even part of clothing, and may take measurements at appropriate intervals. As yet another example, the device may be operated by a technician or healthcare provider.

[0017] Monitor 104 generates values ​​for one or more biochemical markers and provides them to log 106. The log stores multiple measurements over time. The log is made available to a processor or controller 108, which analyzes new log entries against previous log entries and then generates an alert 110, which is transmitted by an alert transmitter or communication interface 112. The transmitted alert may be used solely to identify anomalies, or there may be alerts for normal results. Alerts may be used solely to indicate that a patient needs to be examined, or they may be issued to indicate that the patient's health is good or stable. The log allows for comparison of measurements over time. Most markers have healthy and unhealthy levels. These levels may vary from patient to patient. The log allows for identification of unhealthy levels as deviations from the normal healthy level range. When using markers to assess recovery, the markers can be monitored to determine whether the patient's health has improved compared to an initial state.

[0018] In the example in Figure 1, the alert status is determined by a controller 108 connected to the log. This controller may be part of a local device operating with the monitor, or it may be part of the monitor itself. Alternatively, the controller may be connected via a communication interface 112 to a server system 116 or another system that provides additional information for use in determining the alert. As a further alternative, information may be sent to the server system or another remote device to determine the alert. In this case, the controller receives the remote determination and issues an alert accordingly.

[0019] After being generated, the alert is sent to one or more different entities as appropriate, depending on the specific embodiment. The alert may be sent directly to the patient 102 via line 120, or indirectly via other recipients. The alert may also be sent to, for example, a clinic or hospital 114, a server system 116, the attending physician 118, or other appropriate person involved in the patient's health. The alert may also be sent to friends or family.

[0020] The server or analysis system 116 stores and analyzes the received data. The system can be used to determine the severity of an alert and then to determine other stakeholders, such as a doctor or clinic, to send the alert. If the system receives data from many other patients, it can analyze the data to look for trends and determine a health baseline. Various data analyses can be applied to identify and analyze patterns that have occurred. Alerts may be used to establish communication between a doctor 118 or clinic 114 and a patient 102. Communication may take the form of a request to make an appointment or to undergo additional tests. In other words, if an alert indicates that a patient is ill or their condition is worsening, the doctor or clinic can notify the patient to arrange a consultation. Appointments can be used to determine early diagnosis and to plan treatment.

[0021] In some embodiments, the alert does not indicate a specific illness or disease. The next step in the process is to gather more information. The patient may collect several diagnostic pieces of information individually and provide them to a doctor or clinic. The patient may also report to a local clinic or medical office where diagnostic information may be collected. The patient may also meet with or contact a doctor or other specialist to have additional measurements performed to obtain a diagnosis. Unlike many systems, the presence of an alert condition does not indicate the presence of a specific disease. No specific disease is being monitored. Instead, the alert indicates a general amount of health or illness, and in the next step, the patient is diagnosed to identify the cause of the alert.

[0022] Figure 2 is a process flow diagram of a specific example of the operation of a system like the one in Figure 1. Figure 1 begins with the measurement of a biochemical marker in or on the patient's body. In many examples, the marker may be the patient's urea concentration. However, many other markers can be used, as will be described in more detail below. Urea is a soluble crystalline nitrogen compound produced in the human body when proteins are broken down. It is mainly found in urine, but is also found in blood, saliva, and other body fluids. Because urea is produced by the breakdown of proteins, the urea concentration in the body increases as the rate of catabolism in the body increases. Catabolism is the degrading part of metabolism, which involves generating energy from proteins to support processes and activities necessary for maintaining life. Urea can be used to identify the energy demands being supplied in the body. This can be compared to the patient's physical activity level.

[0023] Each individual will have a normal, typical, or usual range of urea concentration in specific parts of their body. This normal range reflects healthy metabolism and normal bodily function. This concentration changes with activity levels and before and after meals. Urea concentration is an example of a catabolic marker that is easy to measure and indicates an abnormality in health. If urea concentration is high when the patient is not exercising or has not finished eating, it means that the body's metabolic activity is increased for another reason. A common reason is that the immune system or other protective or regenerative systems of the body are more active than usual. In this specification, high urea concentration is used as an indicator that an exogenous pathogen is at work or that there is internal injury stressing the body. Catabolic markers may not be able to distinguish between fever and a damaged spleen, but both events are detected as increased physical activity of unknown origin.

[0024] In 204, the measured urea concentration or other marker value is sent to log 106 or another storage device along with a timestamp. Measurement and logging are repeated so that the log retains a history of measurements accumulated over time. In 206, the log stores the measured quantities along with their respective timestamps. This makes the measurement history available for analysis. The log values ​​are analyzed in 208 to determine whether there are any alert conditions. Various alert conditions can be supported. An alert may be issued if the patient is normal, healthy, or consistent. An alert may be issued for deviations from normal, or for various amounts of deviation from normal. The analysis may be performed on the local controller or processor 108, remotely, or using a combination of local and remote resources. The process for analyzing the data is described in more detail below.

[0025] Various different alert conditions can be used individually or in various combinations. At its simplest level, this alert may indicate whether a patient is healthy or ill, and if ill, to what extent. This amount of illness can be called the illness value. The level of illness or illness value can be used to determine how quickly medical care should be provided. For such alerts to function, the system can determine what is normal and can isolate or correct for other factors that affect the catabolic rate but are not disease. In one embodiment, when a patient is known to be healthy, the patient is initially measured multiple times. These measurements can be used to establish a healthy range for that particular patient. Variations outside that range indicate that the patient may not be healthy. After the alert and diagnosis, if the patient is indeed diagnosed as healthy, the health range used to determine the illness value or illness alert may be adjusted. To isolate other factors, the patient may be asked to provide measurements at the same time each day, and to choose times that are not close to exercise and meal times. Alternatively, different health ranges may be determined for different times of day. In such cases, the alert may simply be generated when the urea concentration is outside the normal range.

[0026] A baseline or normal pattern can be determined using multiple stored measurements. Log entries for each measurement allow for comparison of measured marker values ​​over time. A baseline level or normal pattern can be established using these log entries. The baseline or pattern can then be used to compensate for diurnal or cyclical fluctuations in markers, including those related to diet, exercise, and medication. The difference between a more recent measurement and the baseline, pattern, or previous measurement can be compared to a threshold. Log entries with a difference greater than the threshold correspond to an alert condition. A more complex approach using patterns involves comparing log entries to find a normal pattern. If a log entry does not fit a normal pattern, an alert or disease state is determined.

[0027] As a further alternative, the alert status may be determined by analyzing the first, second, or higher-order derivatives of the measurement over time to find the difference of the recent measurement to a baseline level or a normal pattern. Another approach to eliminate diurnal or other periodic fluctuations is to apply a Fourier transform to the stored measurement to remove periodic fluctuations. Alternatively, stored log entries can be rendered as images. Image recognition techniques can be used on the images to detect characteristic disease patterns in the images.

[0028] As mentioned above, various approaches may be used to determine disease status or disease values ​​using values ​​logged over time. Using biochemical sensors and signal processing applied to the sensor signals, a denoised, normalized spectrum can be provided that enhances the signal of a marker, such as urea concentration. To detect disease, at a simple level, the relative changes in the signal or concentration of a marker can be monitored over time. This can be done by evaluating the rate of change over time, such as the rate of increase or decrease per hour. First-order rates of change over time eliminate many simple noise sources in the signal. Second-order (and even higher-order) derivatives may be evaluated over time to improve sensitivity and specificity. This may improve discrimination beyond normal variability.

[0029] Accuracy can be further improved, for example, by removing regular periodic fluctuations using Fourier transforms. Periodic fluctuations can also be removed by evaluating the patient's daytime patterns and correcting for them.

[0030] By rendering log values ​​as images, image classification techniques, such as those prevalent in artificial intelligence systems (e.g., Resnet, convnet, GANs), can be used. Including other signals, such as signals created from measured lactate concentrations, can make the images more detailed. Some images define the X-axis by wavenumber and the Y-axis by time. Image classification systems can be tuned to distinguish true signals and remove spurious biological and system-acquired noise.

[0031] In 210, if an alert condition or disease condition is detected, for example, if the urea concentration is outside the normal range, an alert is generated for that condition. In 212, the alert is sent to the relevant parties, such as the patient, friends, caregivers, doctors, clinics, hospitals, or one or more of these parties and other parties. If there is no alert condition, the process returns to 202 to await further measurements from the monitor. In 214, patients in an alert condition are diagnosed and a disease is determined. If a disease is found in 216, treatment for the determined disease is administered in 218. This process can then be repeated from START. If there is no disease, the process can similarly be repeated from START. If the system frequently generates false alerts, an evaluation may be necessary to determine whether there is an error in the measurement in 202, an error in the evaluation of the measurement in 208, or a malfunction in other parts of the system.

[0032] The described systems and methods may, in many cases, be more sensitive than the patient in detecting diseases to be diagnosed. Therefore, this system may allow patients to submit diagnoses or schedule appointments earlier than they would otherwise. For example, if a patient has an infection, they may not immediately realize it. Simultaneously, the immune system is activated to fight the infection, leading to increased catabolism levels. This can be detected by biochemical marker measurement tools, alerting the patient or physician. As a result, treatment can be initiated several days earlier during normal consultation hours, rather than waiting until the infection reaches a critical stage and the patient becomes seriously ill.

[0033] Infections are a common example, but the same or different catabolic markers can indicate many other diseases before a patient becomes aware of their illness. In some cases, catabolic markers may indicate an unhealthy state even if the patient has no noticeable symptoms. Some diseases have no severe symptoms, some are asymptomatic, and some present with symptoms similar to other common illnesses. Furthermore, some patients are not particularly sensitive to the symptoms of their illness and may not notice them even when they are present. Catabolic markers can help overcome each of these situations.

[0034] In the readmission scenario described above, as shown in Figure 2, patients can be monitored, and alerts can be issued to both the patient and the hospital if the patient's condition worsens or does not improve. Typically, the patient's catabolic rate is high at discharge. However, if the patient's condition improves after discharge, the catabolic rate should decrease. If the concentration of catabolic markers does not decrease or increases, someone can be sent to the patient to investigate their condition. Treatment may be adjusted. The patient may be sent to another clinic to treat the illness, or the patient may be readmitted to the hospital. In some cases, the expected catabolic rate may be adjusted to prevent false alerts. This may result in fewer readmissions, and if readmissions do occur, they will be earlier, allowing the patient's condition to improve and treatment to be more effective and less expensive.

[0035] While the above example uses urea concentration, many other biochemical substances naturally produced in the body can be used as markers. Urea concentration, as mentioned above, is a product of the catabolic nitrogen cycle and therefore serves as an indicator. Other products of this cycle include uric acid, lactic acid, and ammonia. There are also proteins and enzymes released in conjunction with catabolism, such as LDH, CK, AST, and ALT.

[0036] Instead of, or in addition to, catabolism, markers of other natural bodily processes or circulation may be measured. The body produces several different compounds that can be used as inflammatory markers, such as WBC, acute-phase reactants such as CRP, complement, fibrinogen, α2-macroglobulin, and ferritin. These markers indicate that the body is inflamed, but they do not indicate where or how the inflammation is occurring. Instead of inflammation, hydration markers such as total protein, albumin, and osmus may be used to measure hydration reactions. Instead of, or in addition to, catabolic markers, alanine circulation markers such as alanine, α-ketoglutarate, and β-hydroxybutyrate may be used. The alanine circulation is the hydrolysis of proteins in the body that occurs during transamination reactions.

[0037] Other potential markers include amino acids such as glycine and valine. Elevated glycine levels are associated with nutritional deficiencies, which can sometimes be caused by illness. Valine is associated with insulin resistance and diabetes. These and other markers may also indicate muscle and tissue damage due to exercise or other causes.

[0038] These various biochemical indicators are present in various locations within the body and can be detected and measured in various ways depending on the location of detection. Urea, uric acid, ammonia, and many other catabolic markers are found throughout the body. Measurement devices can target saliva, sweat, urine, breath, blood, or other bodily fluids using transcutaneous scans or probes, or scans or probes directed towards the sclera, retina, or other areas of the eye, or scans or probes directed towards any other suitable location.

[0039] Measurement can be performed by analyzing bodily fluids collected and placed in a special chamber. This chamber may be something like a spittoon or a specially fitted toilet containing sensors for analyzing urea and other compounds. In some cases, bodily fluids may be analyzed without a special chamber. The device may be positioned and worn to make contact with the wrist, forehead or other body area using smart clothing, smart shoes or wearables. The device may use a microprobe to support a subcutaneous sensor or for transdermal measurements such as electrophoretic measurements, differential measurements of electrical resistance using alternating current or pulses, or other measurements. In some embodiments, the sensor may be implanted subcutaneously or subdurally in the patient to measure biochemical markers. In some embodiments, a smart pill that is taken and passes through the body can be used. The smart pill can be configured to measure catabolic markers or other biochemical markers as described above.

[0040] Instead of, or in addition to, collecting bodily fluids, patients may have their parameters measured using self-contained or separate measuring devices. As mentioned above, the device may be configured to receive the patient's finger into a chamber. The device can then perform transcutaneous measurements of the finger, such as a transcutaneous spectrometer using an optical system. Simultaneously, such a device may collect sweat from the finger and measure pulse rate, oxygen levels, and other physiological data. Another type of optical eye scanner can be used in the eye for measuring scleral reflectivity, analyzing blood vessels, etc. Eye scanners can also measure the patient's pulse rate, blood pressure, and other physiological parameters. These devices may be self-contained and independent, or they may be capable of operating in conjunction with the patient's computer, smartphone, medical terminal, or other type of device.

[0041] There are various methods for measuring the presence or concentration of biochemical markers in a patient's body. In some embodiments, Raman spectroscopy is used. This can be used to measure urea concentration in vivo. This may also be used to measure markers through the skin by contact with the skin (contact transdermal spectroscopy), or it may be applied to bodily fluids collected in a container such as a spittoon or a specially constructed toilet.

[0042] Raman spectroscopy relies on the Raman effect, where light is absorbed by a sample and re-emitted at different frequencies shifted above or below the absorbed frequency. Since Raman spectroscopy typically uses monochromatic absorbed light in the near-infrared or visible range, all re-emitted light is shifted above or below the single frequency of the absorbed light. The re-emitted light is captured, and its frequency and amplitude are analyzed to identify the presence of various compounds in the sample. The amplitude of the frequency indicates the concentration level. Raman spectroscopy can be performed using a monochromatic probe laser to illuminate the sample, an image sensor to record the re-emitted frequency and its associated amplitude, and a processor to analyze the recorded frequencies. Optical and container systems are used to guide the absorbed light and collect the emitted light. In some embodiments of this specification, a patient's finger, earlobe, etc., is used as a sample container, and the optical system guides the laser through the skin and collects the re-emitted light through the skin.

[0043] The magnitude of the Raman signal increases near a suitable surface. This is called surface-enhanced Raman. The Raman signal can be further increased using subcutaneous implants made of appropriate materials.

[0044] In Raman spectroscopy or other measurements, the signal from a detector may contain interference in addition to the desired signal. This interference can arise from ambient light, noise within the detector, or other sources. Raman probe lasers can be modulated so that the resulting signal can be distinguished from the interference.

[0045] Raman spectroscopy is sometimes suitable for transdermal application using commonly available components, but in some cases other measurement techniques can also be used. Similar hardware can be used for far-infrared and mid-infrared spectroscopy. Plasmon resonance is another optical technique for detecting compounds. Fluorescence-based nanotube techniques can also be used to detect compounds. In other examples, selective ion probes can be used to detect some small molecules, such as embedded urease. Nuclear magnetic resonance (NMR) uses protons, 14 N compounds and 15 Quadrupole NMR is a detection technique that can be used to detect complex or heavy targets such as N compounds. 14 It can be used to detect compounds containing N. NMR can be used to detect compounds in vivo. Magnets can be used to measure electrophoretic effects, and mass spectrometry can be used to detect volatile organic compounds in breath or other bodily fluids. As a larger measuring device, a bacterial cytometer or any type of wet chemistry can be used to analyze the concentrations of various biochemical markers.

[0046] As shown in Figures 1 and 2, the operation of the present invention can be seen as having three basic aspects. First, measurements are performed using a monitor. Various different monitoring devices and various possible biochemical markers are described herein. Most of the biochemical markers described change in concentration depending on the amount of catabolism in the patient's body. That is, in many embodiments, the first aspect is to measure the patient's catabolic rate.

[0047] The second aspect is determining the level of disease or health based on the measured catabolism rate (or other biochemical measurements). This determination can be performed locally by a monitoring device or a connected computer. Alternatively, the determination can be performed on a central server and processing system. This allows for the collection of data from multiple patients, enabling the application of various artificial intelligence, data analysis, trend analysis, and other techniques. The third aspect is performing the analysis locally and centrally.

[0048] The third aspect is the action taken based on the analysis results. If the analysis is simple, the results will be examined further. Catabolism markers are indicators of overall health, not of a specific disease. High or excessively low catabolism does not determine what should be done for the patient, so the next step will be to examine the patient in more detail and determine the appropriate type of treatment if necessary. As mentioned above, the attending physician or clinic may notify the patient to come in for an examination. If monitoring is being conducted in a post-operative setting, the patient may be readmitted to a hospital or outpatient facility. If monitoring is being conducted at a clinic, it may simply be a matter of informing the appropriate staff at the clinic to come in and examine the patient.

[0049] The described system and methods enable far greater accuracy and superior analysis than before. This is partly due to the frequency of measurements, the time and date stamps associated with the measurements, and the ability to receive measurements from many different patients in a central server. Further enhancement is the provision of scheduled consultation results to the central server system. With such information, trends and patterns can be identified, and based on the patient's typical changes in catabolism throughout the day, a patient can be determined to be healthy. Conversely, another patient may be determined to be unhealthy even if their catabolism pattern is within the healthy range, if it matches the catabolism pattern of a patient diagnosed as unhealthy during the examination.

[0050] Figure 3 is a messaging diagram showing a sequence of messages and actions according to an embodiment of the present invention. The terminals or messaging nodes in this configuration are similar to those shown in Figure 1. In this example, there is a monitor 302 that performs tests on a patient to measure the amount of biochemical markers such as catabolic markers. This monitor is connected to a local terminal 304, which receives the test results and transfers the results to a connected central server 306, which stores all the test results for this patient and many other potential patients. A clinic 308 is connected to the central server to receive the test results and examine the patient.

[0051] The process begins with the monitor performing a new test on the patient to measure the amount of a biochemical marker. In 310, a test request message is generated. In this example, the test request is generated by the server system and sent to the monitor via the local terminal. The test request may instead be generated by the monitor or the local terminal. The test request may be based on a schedule, such as a time, or on other information from a central server or clinic. In response to the test request, in 312, the test is performed on the monitor to measure the amount of the marker. The test result 314 is sent to the central server via the local terminal.

[0052] The central server, at 316, analyzes the results and determines whether the test results indicate an alert condition. If an alert condition is indicated, an alert 318 is sent to the local terminal, monitor, clinic, and other relevant terminals within the system. The alert sending conditions and alert recipients can be adapted to suit various embodiments and situations. In this example, the local terminal acts as a communication and messaging node for the patient, allowing test requests and appointments to be made through the local terminal. In other examples, a separate messaging node would be used for these purposes.

[0053] When the clinic receives an alert, it activates the scheduler at 320 to determine an appropriate time to see the patient. The specific action taken by the clinic and the urgency of that action may be determined by the nature of the alert. Some alerts are saved for later reference, while others may require immediate attention. In this example, the scheduler schedules an appointment and sends an appointment request 322 to the local terminal. The patient can review the request and respond. The local terminal sends a response 324 to the clinic, and the patient then attends the appointment at the clinic where the appointment will take place. In some cases, the alert may be more urgent or serious, and the patient may seek treatment at a hospital. The clinic may be used to schedule a hospital appointment, or the appointment request may indicate that the patient should schedule an appointment at a hospital. Other types of appointments can be scheduled outside of the clinic in a similar manner. In other cases, such as post-operative monitoring, the clinic may be a hospital.

[0054] Following the examination, at step 326, the diagnosis is sent to the central server. The central server logs the examination results and the corresponding diagnosis at step 328. This log can be used to analyze this patient and other patients, depending on other examination results. The diagnosis may indicate that the patient is healthy or that the patient has a specific illness. The diagnosis may also include an indication of the severity and urgency of the condition. All of this information may be compared with other examination results in the server system to better determine how to analyze subsequent examination results and what types of alerts to send.

[0055] Figure 4 is an alternative messaging diagram showing a sequence of messages and actions according to a different embodiment of the present invention. In this example, a monitor 402 that performs tests on patients is connected to a local terminal 404, which receives the test results and forwards them to a clinic 408. The clinic is connected to a central server 406 that functions as a record repository. In this example, analysis and test scheduling are performed by the local terminal, which may or may not be integrated with the monitor. The clinic performs the same operations, but is connected to the local terminal instead of the central server.

[0056] The process is initiated by generating and sending a test request message 410 to the monitor. As shown in Figure 3, in this example, the test request is optional. The test can be initiated in any of several different ways, such as by the patient or the technician. In 412, the test is performed on the monitor in response to the test request to measure the amount of marker. The test results 414 are sent to a local terminal, where they are analyzed in 416.

[0057] The local terminal can analyze the test results in 416 using data received from external sources, data collected over time, or any other data that provides a more detailed explanation, to determine whether the test results indicate an alert condition. If an alert condition is indicated, an alert 418 is sent to the clinic. The alert may also be sent to a monitor to draw the patient's attention, if necessary. In this example, the local terminal functions not only as a process control terminal but also as an interface with the patient. Alerts and appointments are arranged accordingly through the local terminal.

[0058] When clinic 408 receives an alert, it activates the scheduler at 420 to determine an appropriate time to see the patient. The appointment time may depend on the nature of the alert. The clinic's scheduler schedules the appointment and sends an appointment request 422 to the local terminal. The patient can review the request and respond. The local terminal sends a response 424 to the clinic, and the patient attends the appointment at the clinic where the appointment will take place.

[0059] Following the examination, the diagnosis is sent to the local terminal at 426. Alternatively, the results can be sent to a central server 406 at 428, which logs the examination results and corresponding diagnosis. The logs can be used for record keeping, data analysis, or various other purposes as described herein. While the examples in Figures 3 and 4 show that the results are an examination and diagnosis, other actions can also be taken in response to the test results. One action is to log the data and await the next test measurement. Another action is to request another test. Test results may need to be repeated for verification as they may be significantly outside the normal range. Alternatively, other tests can be performed to confirm the patient's suspected condition. Instead of a request for an examination, the clinic may send a questionnaire to the patient via the local terminal so that the patient can provide any symptoms or signs to the clinic. This questionnaire can then be used to determine whether an appointment is necessary.

[0060] Figure 5 shows a diagram of a benchtop NMR urea measurement system connected to a data center or server system and a care center, clinic, or hospital, according to another embodiment. The benchtop unit 502 provides rapid and easy health monitoring of a patient 510. It may optionally be complemented by a data center 504 for analyzing results and a care center 506 for providing any care deemed appropriate based on the measurements. Alternatively or additionally, the measurement unit may be directly operated by the patient 510 and alert the patient when action should be taken based on the measurements.

[0061] In this embodiment, the measuring instrument is a tabletop unit. Here, table 508 supports an NMR measuring instrument 520 having a sensor 522 for NMR measurement. The sensor is controlled by a microprocessor or controller 524 that performs the measurement and determines the result. The microprocessor stores the measurement quantity in memory 532, from which the measurement quantity can be immediately transmitted via a wired or wireless input / output (I / O) interface 526. The measuring instrument is powered by a power supply 530 connected to a mains power supply 512. This may be backed up by a battery system within the unit. A larger battery may be used to allow the unit to be transported to a patient and operated temporarily away from the table.

[0062] The measuring instrument has a user interface 528, which can be used to alert the patient to perform a measurement, enable the patient to perform the measurement, and provide the patient with the results. The user interface may have a power switch, status indicators such as LEDs, multi-color LEDs, or any other suitable display, buttons, and may include a touchscreen display and audible alerts. In one example, measurements are performed at regular intervals. The measuring unit provides an alert via the user interface indicating that it is time to measure. The processor can generate alerts based on an internal calendar or timer, or by receiving commands from an external source via the I / O interface. The alerts may be in the form of a buzzer, a lamp, or a display on the user interface. The I / O interface can send alerts to the patient using Wi-Fi®, Bluetooth®, SMS, or other interfaces to a computer, tablet, phone, wearable, or other suitable device.

[0063] Upon receiving an alert, the patient comes to the measuring device and undergoes the test. In this example, the NMR measuring device includes a sensor tube 534 having an opening at one end, allowing the patient to insert their finger into that tube or cylindrical sleeve of the measuring unit. Depending on the particular embodiment, the patient may insert a finger, earlobe, toe, or other suitable part of the body into the spectrometer and press an activation button on the UI or wait to be detected. The spectrometer may alternatively be configured to be positioned beside the skin to measure the wrist, forehead, or other body part. The finger may be detected automatically, or the patient may provide instructions to the user interface, such as pressing a button.

[0064] Subsequently, the measurement unit performs appropriate measurements of appropriate indicators. In one embodiment, an electromagnetic pulse in a cylinder perturbs the nuclear spin of the patient's atoms, and the resulting echoes emitted from the patient are detected by a pickup coil or similar device. A magnet generates a constant magnetic field during this process. The detected signals are then analyzed to measure the presence and quantity of one or more biochemical markers. Once the measurement is complete, the user interface provides the patient with an audible or visual indication that they can remove their finger.

[0065] In this embodiment, nuclear magnetic resonance spectroscopy is used as the measurement method. Permanent magnets surrounding the finger tube generate a magnetic field applied to the finger. Probe coils of the measurement unit surrounding the finger tube apply electromagnetic waves to the finger, measuring the electromagnetic response of the finger and providing measurement results. In this way, various isotopes, such as nitrogen, oxygen, and sodium isotopes, can be detected. In this case, nitrogen isotopes... 15 Using N, we measure the chemical shift characteristic of urea. The magnetic response of the finger is 15 The concentration of N is analyzed by an internal microprocessor. This is used to estimate the concentration of urea, which can be used as an indicator of overall health.

[0066] Standard NMR detects only nuclear isotopes with an odd atomic number. Natural nitrogen is 99.6% 14 N and 0.4% 15 N. Urea has two nitrogen atoms and is easier to detect than other compounds, but in most cases, both atoms are 14 N and cannot be detected. The presence of two nitrogen atoms is useful because it gives two chances for one of them to be 15 N. Also, urea contains a significant amount of carbon. Natural carbon is 98.9% 12 C and 1.1% 13 C. Therefore, in both cases, the isotopes with an odd atomic number are about 1% of the total number.

[0067] Alternatively, nuclear quadrupole resonance (NQR) spectroscopy can be used in a desktop unit sensor. NQR detects 14 N without necessarily applying an external magnetic field. In addition to or instead of the above-described ones, other types of sensors can also be used.

[0068] The health status data can be stored in the memory 532 of the measurement unit 502 and then transmitted to the data center 504 from time to time via the I / O interface 526. The spectrometer is coupled or integrated with the communication module 526. This module includes a buffer for storing the measured quantity and a wired or wireless transmitter for transmitting the buffered measured quantity via a wired or wireless interface. The communication module can locally store a log of the measured quantity and provide local access to a local terminal via a local interface. The measured quantity and / or the patient identifier can be encrypted for storage and / or transmission. The interface may be a serial bus connector, a network connector, or a user interface connector. The local interface can be used to directly provide data to the patient or clinician or other stakeholders and can be used to convey an alert to the patient or other stakeholders.

[0069] The communication interface is connected to a data center, which receives measurements and stores them in a mass storage device. The mass storage can be used to store logs for multiple patients over several days, months, or years. A processor unit in the data center is connected to the log and analyzes the log data. A server can be configured to receive measurements from multiple patients and store them in the log. Providing access to data from multiple patients allows for better pattern detection and the analysis of biochemical markers using more advanced techniques.

[0070] The data center has additional processing and storage capabilities, allowing it to compare results from many different patients to arrive at more accurate results. The data center can send these more accurate results to the care center 506 to better treat patients. The data center can also communicate with patients via the measurement unit, or via a computer, tablet, phone, or wearable device. The measurement unit and data center can also send SMS alerts to patients, for example, using a cellular data modem, when there is a significant change in detected urea or when urea reaches a high-risk level.

[0071] Figure 6 is a process flow diagram of the operation of the desktop measurement unit. After startup, unit 502 determines in 604 whether it is time to perform a measurement. This may be based on an internal clock and calendar, or on instructions or commands received from an external device such as a care center 506, data center 504, clinic, or other external agent. If it is time to perform a measurement, the unit alerts the patient 510 in 606. The unit can manipulate audible or visual signals via its user interface 526. Furthermore, or alternatively, it can send alerts to other devices using wireless or wired connections. The unit can send emails, texts, notifications, or other displays.

[0072] The patient responds to the alert by coming to the unit and inserting the appropriate finger into the examination opening 534. If the patient does not respond within a predetermined time, the unit may provide the patient with further alerts and may also warn the care center or other external monitor that the patient is unresponsive. A technician or other healthcare provider may then be dispatched to assess the patient's condition. At 608, the unit determines that the patient has inserted a finger into the measuring NMR unit, and at 610, that finger is measured.

[0073] In one example, the unit uses NMR 15 A finger is measured for N. Once a clear raw result is obtained, the unit indicates to the patient at 612 that the measurement is complete. The raw measurement is analyzed by the unit's processor at 614 to estimate the urea concentration. The urea concentration value is then stored by the unit at 616. The measurement can also be sent to the data center 504 for further analysis and to back up the unit's memory. The unit can also store the raw measurement and send it for external analysis, depending on the specific embodiment.

[0074] At 618, the unit further analyzes the urea concentration to determine whether the result is outside the expected safe range for urea concentration. For normal or within-range results, the unit may provide the patient with a SAFE or GOOD indication. The measurement timer is restarted, and the process is repeated at 604. If the result is out of range, the unit may provide a different type of alert at 620.

[0075] The processor unit can be configured to determine the type and details of the alert, and where the alert will be sent. The unit can notify the patient via a local terminal or the unit's user interface. The unit can notify a clinic, hospital, or other location instead of, or in addition to, notifying the patient. The clinic can connect to the data center via a wired or wireless interface such as the internet or a proprietary or virtual network, and can also connect to the patient's local terminal and care center. In some cases, the data center 504 may be located within a hospital or clinic 506. As described above, the alert may prompt the clinic to schedule an appointment for the patient for further analysis to determine whether the patient is in need of treatment.

[0076] Alerts for out-of-range conditions or other illnesses may be provided to one or more of various different stakeholders, as described above. Patients may be alerted so that they can go to a care center for further examination. Care centers may optionally receive alerts, in 622, so that patients are scheduled for more detailed analysis or examination. Data centers can use the information in conjunction with other information. An examination may be scheduled after an out-of-range alert has been generated and sent.

[0077] After a patient is further diagnosed, the clinic can send the diagnostic results to a data center. This allows the data center to supplement the patient's logs. The log metrics stored in the data center can then be correlated with the diagnostic results. This enables the system to provide more accurate, personalized alerts. Furthermore, one patient's metrics or measurement patterns can be compared to those of other patients to improve the outcomes for other patients. Patient identifiers in the logs may be encrypted to protect the patient's medical privacy.

[0078] Figure 7 shows an example of an alternative measurement unit suitable for use as a wearable. The wearable measurement unit 702 enables very frequent measurements without interfering with the activities of other patients. In this example, the measurement device can be worn on the wrist 706 or arm 704. The measurement device 702 includes a power source 726 such as a battery or capacitor, a system-on-a-chip (SOC) 720, and a system in a package (SiP) or other processing resources having memory 722. A communication interface 724 may be separate from the SOC or integrated into the SOC. A sensor 718 is housed together with other components in a case that can be attached to the wrist 706 or arm with a strap 708, like a wristwatch. The measurement device may include an electronic or mechanical watch 714. Alternatively or additionally, additional measurement devices may be included to provide functions such as fitness strap functionality. A display 712 and user controls 716, e.g., buttons or a touchscreen, can be used to provide smartwatch functions such as notifications, alerts, and communications, and can also be used to allow the user to operate the measurement unit.

[0079] The sensor 718 can be measured using transcutaneous Raman spectroscopy applied to the wearer's wrist. Furthermore, as described above, urea can be measured using Raman spectroscopy. Water concentration can also be measured to convert the urea measurement into a concentration. Body tissues and fluids contain a significant proportion of water, but this amount can vary depending on the body part and time of day. By measuring the water spectral line in addition to the urea spectral line, the urea concentration can be provided using the ratio of their measured amounts. The ratio to water can also be used to correct for coupling variations. This approach can also be used in any other embodiments described herein.

[0080] The measured quantity can be stored in memory 722 and then transmitted externally using the communication interface 724. Alternatively, the measured quantity can be directly displayed to the user on the display 712. The measuring instrument can transmit the measurement results to an external device using any of the following wired or wireless interfaces.

[0081] A wearable device can monitor a patient's condition at any time it is being worn. Measurements may be taken at regular intervals, as determined by the device's programming. The device can also be programmed to measure urea concentration, water concentration, or both at specific intervals, e.g., every 5 minutes, 30 minutes, 120 minutes, 300 minutes, etc. These measurements and timestamps 730 may be stored locally 716, stored in memory 722, and transmitted (724). The device can also be programmed to take measurements during specific time periods. The device can also be configured to allow a patient to command it to take measurements. The device can also be configured to respond to measurement commands received from an external device via a communication interface. The device can also be configured to use an accelerometer to identify when the patient is stationary and perform a measurement at that time. Possible external devices may include a smartphone, computer, or remote server. The device may be controlled using an app or other suitable interface on a smartphone or computer. Smartphones or computers can provide a wider range of user interfaces, offer more complex scheduling and analysis systems, and can be used to send messages to patients, for example via SMS, chat, notifications, or email, to request measurements.

[0082] Because the measuring device is on the wrist, monitoring can be performed frequently or continuously as needed. Frequent, autonomous monitoring eliminates the need for patients to remind themselves to take one or two measurements per day. The measuring device can be configured to enable such measurements. Patients typically exhibit fluctuations in marker levels, i.e., urea concentration, in response to fluctuations in their activity level. Urea concentration can change due to the daytime cycle, meals, exercise, and other patient activities. If the patient's activity, diet, and sleep patterns change, it may be difficult to accurately measure marker concentration throughout the day. Frequent or continuous monitoring allows for the detection and correction of fluctuations in marker concentration due to the daytime cycle, meals, exercise, and any other activities. As an example, a wrist-based sensor may include an accelerometer to detect activity levels, including sleep and exercise, and adjust the measurement cycle accordingly.

[0083] The sensor in this embodiment measures the concentrations of urea and water using Raman spectroscopy. Raman spectroscopy allows for the detection of mid-range infrared spectral features using inexpensive and high-performance near-infrared or visible light sources, detectors, and optics. After the laser excites molecules at the wrist, it generates spectral lines corresponding to molecular vibrations. These can be compared to the spectral lines of known molecules as a method for detecting and identifying molecules.

[0084] As mentioned above, urea is produced in many parts of the body, and urea concentration is a useful indicator for detecting disease. In wristwatch-type devices, the coupling between the sensor and the tissue or fluid being measured changes as the sensor's position changes. Furthermore, the physical coupling between the back of the wristwatch sensor and the wrist can also change due to distance, moisture, and other factors. This can be easily corrected by performing multiple measurements, thereby normalizing the results for the many variations in each measurement.

[0085] Wrist-mounted sensors present complexities in terms of size, power output, and optical coupling with the wrist, but they enable convenient and frequent measurements. They also allow for long-term measurements. Raman spectroscopy typically uses a moderately high-power laser, which allows for a stronger return signal. Common objects emit a significant amount of mid-infrared light at room temperature, and this background noise can reach the sensor's mid-infrared detector, thereby limiting the sensitivity of mid-infrared measurements. High-power lasers consume considerable power from a small wrist-mounted power supply, and the cooled mid-infrared detector consumes even more power. Furthermore, these components are physically larger compared to a wristwatch. Noise issues can also be compensated for by increasing the measurement time.

[0086] Low-power lasers reduce the amplitude of the reflected light signal compared to the background noise. This degrades the signal-to-noise ratio performance. Increasing the measurement time can potentially collect more background noise at the reflected light detector. The background noise at the detector is proportional to time. This further degrades the signal-to-noise ratio performance.

[0087] On the other hand, the reflected light signal is also proportional to the laser output multiplied by time. To compensate for the increased noise, the fluctuations in the noise can be analyzed. Both the signal and the noise increase in direct relation to time, but the fluctuations in the noise increase in proportion to the square root of time (sqrt(time)).

[0088] This square root relationship allows for reduced laser power output to ensure eye safety, power saving, and size reduction while still obtaining useful measurements. As an additional safety feature, an interlock can be provided to determine when the sensor is near the wrist. If the sensor is removed or too far from the wrist, the laser will turn off. The proximity sensor may be the optical sensor of the Raman spectrometer, or a separate proximity sensor may be used on the device. The proximity sensor can be mounted, for example, on the back of the case, facing the user's wrist.

[0089] During use, the measurement unit's controller receives measurement commands from a software timer, user commands, or an external device. The controller drives a sensor to determine whether the measuring instrument is next to the wrist. If so, it drives the sensor to generate an excitation signal and measures the light emitted from the patient's wrist. The measured quantity is analyzed by a processor and then stored in memory. The measuring instrument then terminates the process and returns to the beginning of the process. In another process, the measuring instrument transfers the stored data to an external device such as a smartphone, computer, or server. This process can be performed using conventional protocols, and the transferred data can then be used to diagnose diseases, schedule treatments, or for other purposes.

[0090] As an alternative to the wristwatch form factor, the wearable measurement unit may take the form of other conventional clothing or accessories. For example, the unit may be supported by a belt around the patient's waist. The sensor can be connected by fiber optics to a small sensor head attached to the body by the belt. Alternatively, the sensor may be attached to the abdomen, back, legs, arms, or wrists by some kind of band, such as an elastic band, or by another method such as adhesive tape.

[0091] Figure 8A shows an alternative measurement unit suitable for use as a portable handheld measuring instrument. This portable handheld measuring instrument allows for ease of use by the technician and enables the performance of other types of measurements. In this modification, the portable handheld unit 802 includes a power supply 824 such as a battery or capacitor, a processor 820 such as an SOC, SiP or discrete controller, memory 822 which may be part of the SOC or not, a communication interface 826, and a sensor 806. All of these are housed in a case that can be easily held by hand using the case's handle 810, so that the Raman spectrometer 806 can be directed towards the patient for measuring appropriate health markers such as urea concentration. The instrument may also include additional measuring instruments for providing blood oxygen, temperature, and other measurements. A display 812 and user controls 814, such as buttons or a touchscreen, can be used to provide additional control and communication functions such as notifications, alerts, and communications.

[0092] The sensor can be used to apply transcutaneous Raman spectroscopy to the patient's earlobe, forehead, or other suitable location as a measurement method. Figure 8B is an enlarged side view of the sensor portion of a handheld measuring instrument suitable for the earlobe 840, which is equipped with a clip 842 that allows the operator to hold the sensor fixedly against the earlobe. This allows the laser to be placed on one side of the earlobe and the near-infrared (NIR) sensor to be placed on the opposite side of the earlobe, for example, within the clip 842, to use transmittance measurement. Transmittance measurement allows for measuring pump attenuation, which can then be used to normalize urea measurement. Alternatively, the measuring instrument can also be configured to perform contact measurement with the laser and sensor on the same side. This is also suitable for the forehead, wrist, and other measurement locations.

[0093] In some embodiments, the sensor measures urea using Raman spectroscopy as described above. Alternatively, the water concentration can be measured to convert the urea measurement into a concentration. Body tissues and fluids contain a significant proportion of water, but this amount can vary at different times in different parts of the body. By measuring the water spectral line in addition to the urea spectral line, the concentration of the urea measurement can be provided using the ratio of their measured amounts. The ratio to water can also be used to compensate for coupling variations. In other embodiments, different sensors can be used.

[0094] The measured quantities can be saved for later transfer to an external device. In this example, the instrument includes a base for a handle 810 having a docking connector 828 that connects to a dock 804. The dock may include a mating connector 830 that accepts the base of the handheld unit. The dock may include a USB, Ethernet, or other suitable data connector 832 to supply power for charging the instrument and to transfer data between the instrument and a connected terminal (not shown). Alternatively, a separate power supply or voltage regulator 838 can be used to supply mains power to the handheld unit. The handheld unit can be connected to the connected terminal via the dock using a data interface 834 between the connector and the cable. Alternatively, a wireless interface may also be used for data transfer.

[0095] Subsequently, the dock can be used to transfer measurements to a connected terminal and any updates to the instrument. For example, the dock can be used to transfer software updates, patient information, and spectral calibration data to the instrument. Although a dock is shown, similar functionality can be achieved using a simple USB connector or other types of power and data connectors. The dock connection can be made electrically, inductively, or by other means.

[0096] This handheld unit can easily accommodate a large battery, a powerful laser, and a cooling system for the return optical sensor of the Raman spectrometer. The sensor can be carried by technicians in hospitals, clinics, or other care facilities, allowing them to measure numerous different patients before being recharged. For example, a technician could use the device in a care facility to monitor the health status of each patient during daily visits. Another example is a technician visiting post-operative patients in hospitals, post-operative recovery facilities, or at home daily to monitor the recovery from complications.

[0097] At the end of the day or round, the instrument can be docked and all measurements can be downloaded to a computer via the USB connector. Service and software updates can also be uploaded to the instrument, and the instrument's battery can be charged. Alternatively, other suitable wired or wireless connections can be used.

[0098] Figure 9 shows an alternative measuring unit suitable for use as a portable benchtop measuring instrument for use with collected samples. This benchtop measuring instrument allows for sample collection and measurement by bringing the patient to a designated location or by bringing the measuring instrument to the patient. As with other embodiments, it is suitable for use in homes, clinics, hospitals or any other location. Proper sample collection can be more easily performed by a technician, although patients may prefer to be measured at home.

[0099] The benchtop measuring instrument 902 may be a fixed or portable device. This example includes a housing 904 with a handle 906 for carrying the instrument to different locations. The user interface includes a display 910 and buttons or switches 912. A touchscreen or other suitable interface may also be used. A speaker 913 can be used for audible alerts or other notifications. The housing also includes a tube or cylindrical sleeve 914 for receiving samples for analysis and a port 908 such as a USB port for power and data transfer.

[0100] The functional components within the housing 904 may be similar to those of other embodiments and include a SOC 920, memory 922, battery 924, and communication interface 926.

[0101] A sensor 918, such as a Raman spectrometer, can be used to analyze the urea concentration of a sample placed in a sample tube 914. A sample container 916 can be used to hold saliva samples or any other type of sample. Samples may be collected and analyzed in a disposable or reusable sample container 916 and placed in the sensor tube for analysis. The sample container may be pre-filled with a wetting agent to reduce air bubbles that may interfere with the measurement. Air bubbles can be problematic in optical measurements because they strongly scatter light. Using a wetting agent can lower the surface tension of water in saliva, causing air bubbles to float to the surface. The sensor may provide data to the SOC for analysis and display alerts on a built-in display.

[0102] The internal components and functions may be similar to those of a handheld unit or a desktop finger sensor, but the device can be configured to fit into a larger, heavier form factor. A larger form factor can allow for a more powerful processor, a longer-lasting battery, and a more complete set of communication interfaces, such as data and voice interfaces.

[0103] The desktop unit can be used in care facilities or during home visits, and its larger form factor with greater power, communication capabilities, and battery life is particularly suitable for rounds to more distant locations. The desktop unit can be adapted to measure a finger inserted into a tube. It can also be adapted for use with urine. Body fluids such as saliva and urine provide a strong signal and are easier to measure than the transcutaneous measurements described above. Compared to other body fluids, saliva is easy to obtain and handle. Like other body fluids, the urea level in saliva follows the urea level in the body.

[0104] During use, the technician or patient presents a sample container filled with saliva. The container is inserted into the measuring tube, and the meter is activated. The user interface can be used to input patient information or other appropriate data. The meter then measures the sample for urea concentration or other appropriate markers and analyzes the results. The results may, alternatively, be sent to an external device for analysis via a USB or wireless interface. Analysis results, such as alerts, can then be displayed on the screen. In case of negative results, the patient can schedule an appointment via a separate telephone or computer terminal, or, in some configurations, directly using the meter.

[0105] Figure 10 shows a diagram of an alternative fixed liquid sample collection device suitable for a measuring unit that detects urea. Fixed sample collection provides ease of use for the patient, provided that other functions are sufficiently automated. The measuring instrument 1020 is integrated with the toilet 1002 and is attached to or incorporated into the toilet bowl 1004. Infrared spectroscopy or any other suitable technique can be used to analyze the urine before the toilet is flushed. For increased accuracy, the amount of urine can be measured for use in concentration calculations. The measured volume may be reported to a remote server for analysis using Wi-Fi or a wired connection. Alternatively, the analytical functions described above can be incorporated into the measuring instrument 1020 in a similar manner.

[0106] The measuring instrument 1020 includes a power connection section 1014, such as a connection to a main power supply, or it may use a battery or a capacitor. The measuring instrument further includes a processor 1010, such as an SOC, SiP, or discrete controller, a memory 1012, which may or may not be part of the SOC, a communication interface 1008, and a sensor 1006. They may be housed in a case or integrated into the toilet components.

[0107] The measuring device can be configured to detect when a patient urinates and then activate a sensor before the toilet is flushed. Similarly, urine detection can be used to determine how much urine has been added to the toilet. This can be used to measure the relative volume of urine to the water in the toilet. If the urea concentration is to be determined, comparing the added urine to the amount of water present is useful. Appropriate liquid level detection techniques include pressure sensors, capacitance sensors, optical sensors, and ultrasonic distance meters for measuring the position of the liquid surface in the toilet. These sensors can be integrated into the toilet or attached as accessories.

[0108] Furthermore, since the sensor is installed in a fixed position, it can use the mains power supply. As a result, more accurate and efficient high-power components can be used. The sensor can use a mid-infrared light source and a cooled detector for mid-infrared spectroscopy. This will require more power than some of the variations described above. The mid-infrared light source may be a suitable laser, and the detector may be a silicon photodetector sensor with a suitable optical filter.

[0109] When in use, the "smart toilet" may be shared by various people. If the "smart toilet" is installed in a clinic, hospital, or nursing home, the cost and maintenance of the measurement unit may be shared among many different users. In such use, there will be multiple samples collected in a day, and as a result, some of the advantages of wearable measuring devices can be realized. To distinguish different users, users may enter an access code or provide some other method of identification. This may include some type of autonomous identification such as an RFID code from a bracelet or clothing, a wireless interface on a personal door key, an authentication signal from a smartphone, or facial recognition. In Figure 10, the ID unit 1016 may be an RFID tag reader, a camera, or other signal receiver for identifying a person.

[0110] Figure 11 is a block diagram of a computer system 10 representing an example of a system that can implement the features of the described embodiments, such as the computing system, monitor, measuring instrument, local terminal, server, data center, or clinic of Figure 1, in various exemplary embodiments. Depending on the embodiment and associated equipment, these systems may include or be implemented as such a computer system. The computer system includes a bus or other communication means 1 for exchanging information and processing means, such as one or more bus-coupled microprocessors 2, for processing the information. The computer system further includes cache memory 4, such as bus-coupled random access memory (RAM) or other dynamic data storage device, for storing information and instructions executed by the processor. Main memory may also be used to store temporary variables or other intermediate information during the execution of instructions by the processor. The computer system may also include non-volatile main memory 6, such as bus-coupled read-only memory (ROM) or other static data storage device, for storing static information and processor instructions.

[0111] Large-capacity memory 8, such as solid-state disks, magnetic disks, disk arrays, or optical disks, and their corresponding drives can also be connected to the computer system's bus to store information and instructions. The computer system can also be connected via the bus to a display device or monitor 4 for displaying information to the user. For example, graphical and textual displays of installation status, operating status, and other information can be presented to the user on the display device. User input devices 16, such as keyboards with alphanumeric keys, function keys, and other keys; cursor control input devices such as mice, trackballs, trackpads, or cursor direction keys; and user input devices 16 such as buttons, sliders, wheels, and touchscreens, can be connected to the bus to transmit directional information and instruction selections from the user to the processor. In some embodiments, one or more sensors 18 for measuring catabolism or other markers are mounted on the bus 1 and can operate autonomously or under the control of the processor.

[0112] The communication interface 12 is also connected to the bus. The communication device may include a wired or wireless modem, a network interface card, or other well-known interface devices, such as Ethernet, Token Ring, or other types of physical attachments used to provide a communication link for supporting a local or wide area network (LAN or WAN). In this way, the computer system can also connect to a large number of clients or servers via one or more conventional network infrastructures, including, for example, an intranet or the internet. Additionally or alternatively, the communication interface may incorporate a wireless link, as described above.

[0113] The large-capacity memory 8 can be used to store data for multiple patients, as described above. The data can take the form of tables or any other arbitrary structural format. In this example, the patient measurement table 22 contains measurements for one or more patients collected over time or shared from external sources. There may be different tables for various types of measurements or markers, such as urea, lactate, protein, alanine circulating markers, or different tables for different types of monitors, such as finger, forehead, wrist, or body fluids. There may also be tables for other measurements, such as exercise, pulse, and blood oxygen. The patient record table 24 contains other medical or personal data related to tables that may be required by the clinic, server, physician, or other participants in the system. Again, there may be different tables for each patient. The patient preference table 26 contains various operational or therapeutic preferences depending on how the system is used. This may include display configurations, monitoring times, contact settings, preferred appointment times, or other appropriate settings.

[0114] The described tables can be stored as two-dimensional tables, as text files containing metadata, or in any other preferred method. Data from the patient measurement tables are collected and analyzed by the processor in response to commands from the user interface 16, as indicated by the preference table 26. The system may also be remotely controlled or accessed via the communication interface 12.

[0115] The system in Figure 11 optionally further includes an AI (artificial intelligence) engine 30. This can be implemented using dedicated hardware that utilizes parallel processing, or on processor 2, or using some combination of resources. The AI ​​engine may also be external to the server system 10 and connected via a network node or some other means. The AI ​​engine can be configured to use historical data accumulated by the server system to build a model that includes weights and criteria for application to the analysis process. The model can be iteratively rebuilt using the accumulated data to improve accuracy. Other types of analysis systems can be used instead of, or in addition to, the illustrated system.

[0116] Computer systems are presented as discrete components connected to a bus, but one or more of these components can be combined, or additional components can be added. For example, some or all of the components can be combined with one or more SiPs, or SoCs, or several combinations thereof. While many of the same basic types of components are used, autonomous list monitors, rechargeable handheld monitors, and server centers can also be built using entirely different hardware implementations.

[0117] Figure 12 shows the components of the SOC 720 and sensor 718 according to several embodiments. Among the other components, the SOC optionally includes a motion sensor 732, such as a 3-axis accelerometer, and a real-time clock 734. This can be used to determine whether the patient is active or relaxed and to evaluate the appropriate conditions and time to activate the sensor for measurement. The microprocessor is connected to a power supply 726 and one or more communication modems 724, such as Bluetooth, GSM / GPRS, Wi-Fi, or LTE modems, and the other components as described above. As described above, the basic configurations in Figures 7 and 8 can be adapted to other form factors for wearable devices and standalone devices.

[0118] The microprocessor can operate the sensor by driving other components within the SOC, or optionally components outside the SOC. The laser driver 740 generates power under the control of the microprocessor to produce appropriate light for measurement and calibration in the sensor's laser diode (LD) 750. The thermoelectric cooler (TEC) driver 742 generates power to drive one or more TECs 752 on the sensor. The coolers can be associated with the LD 750, the photodiode (PD) light sensor 756, and other components of the sensor. The TECs can be controlled independently of each other to enable precise control of the sensor components. The thermal sensor interface 744 receives readings from the sensor's temperature sensor 754 and provides them to the microprocessor. The microprocessor can be configured to use this data to control the coolers, LD, and PD. The photodiode interface 746 allows control of the timing, scan rate, and other operations of the PD 756. It also provides PD data to the microprocessor for analysis and logging. The microprocessor also has a user interface module 748 for connecting to the display 712 and user control 716.

[0119] The systems in Figures 7 and 12 can be operated in any of several different ways to suit specific types of sensors, biochemical markers, and patient tissue. More or fewer components than those shown can be used to perform the operation. In one example, the system can be configured to identify when the patient is stationary using an inertial sensor 732, such as a 3-axis accelerometer. The microprocessor's real-time clock can then be used to determine when to acquire the measurement. Measurements can be performed based on a timer, time, or another schedule.

[0120] Subsequently, the photodetector thermoelectric cooler (TEC) 752 is activated, and the temperature sensors 754 of the first and second stages are read to adjust the cooler's drive current. The cooler and sensors are used together to maintain the photodetector 756 at an optimal or preset operating temperature. Various different control techniques can be used. In one embodiment, proportional-integral-differential control techniques are applied. Almost simultaneously, the laser diode thermoelectric cooler 752 is activated, the laser diode temperature sensor is read, and the temperature of the laser diode is adjusted to an optimal or preset temperature using the same or similar control techniques.

[0121] Subsequently, the sensor's laser diode 750 is activated by a microprocessor. The microprocessor may have setpoints for laser diode temperature and drive current to ensure accurate operation. These are started to initial or preset setpoints. The laser and cooler are operated until initial values ​​are achieved and stabilized. The PD interface 746 activates the PD 756 to acquire an initial spectrum from the tissue. This data is stored in memory 722 or a temporary cache.

[0122] Optionally, to achieve higher accuracy, the laser diode temperature and drive current can be changed to second temperature and drive current setpoints to shift the laser optical frequency. The microprocessor then waits for the current and temperature to stabilize at the second setpoint. The PD interface then uses a photodetector to cause the PD to acquire a spectrum and save this additional data.

[0123] After two acquisitions, the spectral data can be analyzed to determine whether the data quality meets a threshold or standard expectation. The process of setting the temperature and drive current and acquiring the spectrum is repeated until a complete measurement cycle is finished. The microprocessor then shuts down the laser, laser thermoelectric cooler, and photodetector thermoelectric cooler. The acquired data can then be analyzed. While a cooler such as a Peltier cooler is described, a simpler heater or other thermal system can be used. The laser output optical frequency can also be adjusted by changing other operating parameters of the laser, in addition to or instead of temperature.

[0124] For example, initial sweeps are averaged together, shifted sweeps are averaged together, and a more accurate value is obtained by subtracting the initial average from the shifted average. By using two different LD optical frequencies and performing multiple scans of the tissue, many sources of error and interference can be eliminated. Additional sweeps may be taken at additional frequencies. Other simpler or more complex techniques can be used to improve signal quality.

[0125] This Raman spectrometer can determine the Raman spectral intensity based on the final sweep value. In one example, partial least squares analysis can be used to arrive at the line intensity. The results can then be logged and transmitted to an external component, including a touchscreen, as described above. Alternatively, the measurement results can be uploaded to a cloud server using an integrated GSM / GPRS modem. The measurement volume may then be reset for the next cycle, and this process may be repeated when the patient is sufficiently still. The measurement interval can also be adjusted based on the risk algorithm and the measurement results.

[0126] Figure 13 is a diagram showing the optical system of the Raman sensor in Figure 12 in more detail. More or fewer optical elements than those shown can be used. The laser diode 750 is thermally coupled to an LD thermoelectric cooler 752-1, such as a Peltier cooler. The cooler stabilizes and adjusts the LD by controlling its temperature. Alternatively, a simpler resistance heater can be used to heat the LD rather than cool it. Other devices can be used to change other laser parameters instead of, or in addition to, the temperature. The laser may be a laser diode with a frequency suitable for Raman spectroscopy of the appropriate type of tissue. Of other types of compact LDs, an appropriate infrared, red, or green LD can be used. For benchtop units, gas and other types of lasers can be used instead.

[0127] The laser illumination is coupled to a collimating lens 760 and optionally passes through an optical isolator 761. The isolator attenuates reflected LD light returning to the laser from tissue or other optical elements. When the reflected light reaches the LD, the energy of the LD changes, which can change the amplitude or frequency of the LD output. Optionally, a second filter, such as an amplified spontaneous emission (ASE) filter 762, blocks or absorbs other light emitted from the LD that would otherwise add noise to the Raman signal.

[0128] The dichroic beam splitter 763 passes the Raman pump signal from the LD to the tissue 767. The energy from the tissue is reflected towards the photodetector 756. After filters 761, 762 and the beam splitter 763, the illumination of the collimated LD 750 is directed and focused towards the patient tissue 767 by another lens or lens system 764. This lens focuses the pump signal to a small tissue area, increasing Raman scattering within that small area.

[0129] The focused beam passes through a sensor window 765 that protects the sensor's internal components from dust, moisture, and other contaminants. This window can be configured to provide an airtight seal against ambient moisture to lower the dew point of the optics. It can be configured to be optically powered. Between the window 765 and the tissue 767 is a spacer 766 to protect the window from the tissue. The spacer also controls the distance between the focusing lens 764 and the tissue. This distance determines the focal position of the pump signal within the tissue. In the example in Figure 7, the tissue is an arm or wrist. However, the tissue may be any other tissue, and may be an extracted sample such as urine, sweat, or saliva, as described above.

[0130] According to the principle of Raman spectroscopy, tissue illuminated by a pump signal absorbs the energy of the pump signal and emits photons of different frequencies or wavelengths, determined by the state and composition of the tissue. Some of this emitted light crosses the spacer 766, passes through the window 765, and is emitted back in the direction of the pump signal, where it is collimated to the beam splitter by the focusing lens 764. Due to the different wavelengths of light emitted from the tissue, the light is reflected by the beam splitter toward PD756 without passing through the beam splitter.

[0131] The emitted light passes through an optional filter 768 to block or absorb any additional pump signal light in the optical path. Following this, there is an optical system that directs the emitted light towards the PD 756, which also has a thermal control system such as a Peltier thermoelectric cooler 752-2 or a simpler heater. In this example, the optical system is compactly configured and designed to guide collimated light across the surface of the PD with minimal attenuation. The system has a focusing lens 769 optically coupled to the reflection from the beam splitter, an optical slit 770, and a curved diffraction grating (DOE) that reflects the emitted light off the optical axis of the beam splitter toward the PD. Various other optical systems can be used instead of other physical configurations.

[0132] Figure 14 shows an alternative optical system for a Raman sensor, as shown in Figure 8B, where the PD is on the opposite side of the tissue from the LD. This system has the same optical elements as Figure 13, except that the beam splitter is removed. Instead, the light emitted from the tissue is received from a different direction. A second spacer 780 positions a window 781 for transmitting the light emitted from the tissue to a lens 782, which collimates the emitted light to a pump signal filter 768, as in the example in Figure 13. The emitted light is then transmitted to the PD 756, as shown in Figure 13.

[0133] Throughout this specification, various processors, controllers, SOCs, SiPs, and other computing components are referenced. Appropriate components can be selected based on power requirements, processing requirements, and cost constraints. For this reason, any one of the controllers, processors, etc., may be an FPGA (Field-Programmable Gate Array), an ASIC (Application-Specific Integrated Circuit) designed for a specific purpose, a microcontroller, and may be a simple embedded processor with appropriate programming, a complete microprocessor with internal program memory and multiple processing cores, or any other suitable type of processor. The controller or processor may include, or be packaged with, memory, communications, display controllers, graphics, user input, and other components. Each example of these components is not intended to require a specific hardware configuration, but rather to illustrate features of particular interest to the embodiments described.

[0134] Embodiments described herein include communication interfaces. In some embodiments, the measuring instrument can be used simply to provide information on a display. A person can then notify the appropriate person of the measurement results or analysis performed directly by the measuring instrument. In other cases, the results are sent to a data center, clinic, or various individuals. Any of various different interfaces can be used. Wired interfaces may include USB, Ethernet, or other suitable wired interfaces. Wireless interfaces may include Bluetooth, ZigBee, Wi-Fi, cellular, e.g., LTE, GSM, GPRS, or any of various other wireless interfaces for transmitting data to external components.

[0135] In some embodiments, power saving is important to conserve battery power. For handheld or wrist-based devices, data can be transmitted to a wired interface after being stored. This has the advantage of low power consumption, but data transmission is delayed. In other examples, data is transmitted to another device, such as a smartphone or computer, using a suitable short-range, low-power system such as Bluetooth, and these devices can then transfer the data to an external data center or clinic located remotely. The smartphone or computer acts as a relay in this example. With the recent development of the Internet of Things (IoT), additional low-power transmission protocols for Wi-Fi Low and 5G LTE have been developed, and as low-cost components become available, either of them can be used as an alternative.

[0136] As mentioned above, in some cases, a smartphone or computer functions as a relay between the measuring instrument and a remote node. However, a smartphone or computer can also function as a data processor, analyzing data and determining appropriate alerts. A smartphone or computer can be used to collect results over time and receive relevant data, thereby providing accurate analysis to the user locally. A smartphone or computer can also be used as part of a user interface. Smartphone or computer apps can enable more detailed measurement information or more precise control of the measuring instrument. A smartphone or tablet can be used as a portable auxiliary control interface for operating the measuring instrument.

[0137] In certain embodiments, it is possible to use fewer or more equipped sensors, monitors, terminals, clinics, or server systems than those described in the embodiments above. Therefore, the system configuration will vary from embodiment to embodiment, depending on many factors such as price constraints, performance requirements, technical improvements, and / or other circumstances.

[0138] Many of the operations described herein can be performed under the control of a programmed processor, such as a central processing unit or microcontroller, or by any programmable or hardcoded logic, such as a field-programmable gate array (FPGA), TTL logic, or application-specific integrated circuit (ASIC). Furthermore, the methods of the present invention can also be performed by any combination of programmed general-purpose computer components and / or custom hardware components. Accordingly, what is disclosed herein should not be construed as limiting the invention to any particular combination of hardware components.

[0139] This specification uses specific terms such as monitor, marker, clinic, patient, doctor, health, disease, sign, and symptom to illustrate examples. While these terms are used to provide consistent and clear examples, the invention is not limited to any of these specific terms. Similar ideas, principles, methods, apparatus, and systems may be developed using different terminology, either entirely or partially. Furthermore, the invention can be applied to ideas, principles, methods, apparatus, and systems, often centered around various usage models and hardware configurations.

[0140] This specification includes numerous specific details for illustrative purposes to provide a complete understanding of the invention. However, the invention can be carried out without some of these specific details. In other embodiments, well-known structures and devices are shown in the form of block diagrams. Specific details can be adequately provided by those skilled in the art for specific embodiments.

[0141] Embodiments of the present invention include various steps, which can be executed by hardware components or embodied by machine-executable instructions such as software instructions or firmware instructions. Machine-executable instructions can be used to cause a general-purpose or dedicated processor programmed with the instructions to execute the steps. Alternatively, the steps can be executed by a combination of hardware and software.

[0142] Embodiments of the present invention and parts thereof can be provided as a computer program product that includes a machine-readable medium, wherein the machine-readable medium stores instructions used to program a computer (or other machine) to perform a process according to the present invention. The machine-readable medium may include, but is not limited to, a floppy disk, optical disk, CD-ROM, magneto-optical disk, ROM, RAM, EPROM, EEPROM, magnetic card or optical card, flash memory, or any other type of medium suitable for storing electronic instructions.

[0143] While this disclosure has described in detail exemplary embodiments of the present invention, it should be understood that the present invention is not limited to the embodiments described herein. That is, this specification and drawings should be taken as illustrative, not restrictive. Various adaptations, modifications, and changes can be made within the scope of the present invention as defined by the appended claims.

Claims

1. A method for operating a device for evaluating a patient's overall health status, The monitor repeatedly measures the amount of urea as a biochemical catabolism marker in the patient transcutaneously at different times to obtain multiple measurements, A controller saves multiple measurements to a log associated with a patient, wherein each measurement has a timestamp associated with that measurement. The controller performs the steps of determining the patient's urea level based on changes in multiple measured amounts of urea, If the calculated urea value exceeds a threshold, the controller determines an abnormality in the patient. The controller generates an alert indicating the abnormality but not indicating a specific disease or illness; A method characterized by comprising the step of an alert transmitter sending an alert to a patient in order to advise the patient to identify the cause of the alert.

2. In the method according to claim 1, A method characterized in that transdermal measurement is performed on the finger, earlobe, hand, or arm.

3. In the method according to claim 1 or 2, A method characterized in that the measurement includes measurement using at least one of the following: a Raman spectrometer, a mid-infrared or far-infrared spectrometer, a nuclear magnetic resonance spectrometer, a mass spectrometer, a gas chromatograph, or a selective ion probe.

4. In the method according to any one of claims 1 to 3, A method further comprising the steps of: a transmitting means transmitting an alert to a clinic located remotely; and the clinic scheduling a patient consultation related to the alert.

5. A method for operating a device for evaluating a patient's overall health status, The monitor repeatedly measures the amount of urea as a biochemical catabolism marker in the patient transcutaneously at different times, A step in which the controller logs the measured quantity as an entry associated with the patient, wherein each measured quantity has a timestamp associated with that quantity. The controller performs the step of analyzing the stored measured amount by comparing the amount of urea across multiple log entries, The controller determines an anomaly when a recent entry differs from a previous log entry. A method characterized in that the controller determines an alert status relating to a patient.

6. In the method according to claim 5, A method for determining an anomaly, comprising comparing the most recent entry with a baseline level established from a plurality of stored measurements.

7. In the method according to claim 6, The method is characterized in that the baseline level corrects for periodic fluctuations in biochemical catabolism markers over time.

8. In the method according to claim 5, A method for analyzing a stored measurement, characterized by including the application of a Fourier transform to the stored measurement.

9. In the method according to claim 6, A method for analyzing stored measurements, characterized by including the analysis of the first, second, or higher-order derivatives of recent entries over time to determine the difference of recent entries to the baseline level.

10. In the method according to claim 5, A method for analyzing stored measurements, characterized by including rendering the stored measurements as images and utilizing image recognition techniques for detection.

11. In the method according to any one of claims 1 to 10, A method characterized in that urea levels indicate a state of muscle or tissue breakdown, inflammation, or hydration.

12. In the method according to any one of claims 1 to 11, A method characterized in that, when an alert condition is determined by the scheduler, the scheduler further includes the step of sending an alert condition to a remote component to request a patient examination.

13. In the method according to any one of claims 1 to 12, The scheduler determines when the measurement time occurs based on the schedule, The scheduler performs the steps of generating a notification of the measurement time, A method further comprising the step of a server receiving a measurement in response to a notification.

14. Computer-readable medium, When executed by a computer, The steps include repeatedly measuring the amount of urea as a biochemical catabolism marker in a patient transcutaneously at different times to obtain multiple measurements, and A step of saving multiple quantities to a log associated with a patient, wherein each measured quantity has a timestamp associated with that quantity. A step to determine the patient's urea level based on changes in multiple measured levels of the patient's biochemical catabolic markers, If the calculated urea level exceeds the threshold, a step is taken to determine if there is an abnormality in the patient. A step of generating an alert that indicates an anomaly but does not indicate a specific disease or illness, The steps include sending an alert to the patient in order to advise them to identify the cause of the alert, A computer-readable medium characterized by including instructions that cause the computer to perform an operation having the above characteristics.

15. A means for repeatedly measuring the amount of urea as a biochemical catabolism marker in a patient transcutaneously at different times to obtain multiple measurement values, A means for storing multiple quantities in a log associated with a patient, wherein each measurement has a timestamp associated with the respective measurement; A means for determining a patient's urea level based on changes in multiple measured amounts of urea in the patient, A means of determining an abnormality in the patient when the calculated urea level exceeds the threshold, A means for generating an alert that indicates an anomaly but does not indicate a specific disease or illness, A means of sending an alert to the patient in order to advise the patient to identify the cause of the alert, An apparatus characterized by including

16. To obtain multiple measurements, a sensor is used to repeatedly measure the presence of urea as a biochemical catabolism marker in patients transdermally, A log that stores repeatedly measured quantities and timestamps associated with each measurement, A processor that analyzes multiple measured values ​​in a log by comparing them with each other to determine whether or not there is an abnormality in the patient, A device characterized by comprising a transmitter that sends an alert when an abnormality is detected in a patient.

17. In the apparatus according to claim 16, The sensor is characterized by comprising a Raman spectrometer having a laser guided to a patient, a focusing lens for coupling the laser light to patient tissue, a spacer for determining the distance from the patient tissue to the focusing lens, and a photodetector for detecting the energy emitted from the patient tissue to which the laser light is coupled.

18. In the apparatus according to claim 17, The apparatus is further characterized in that the processor drives the laser at multiple different temperatures or other operating parameters to generate multiple different laser light frequencies for bonding to patient tissue.

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