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Background: We evaluated the feasibility, safety, and efficacy of a 2D-planar robot for minimally supervised home-based upper-limb therapy for post-stroke hemiparesis. Methods: The H-Man, end effector robot, combined with web-based software application for remote tele-monitoring were evaluated at homes of participants. Inclusion criteria were: strokes > 28 days, Fugl-Meyer Motor Assessment (FMA) > 10-60/66, presence of a carer and absence of medical contraindications. Participants performed self-directed, minimally supervised robotics-assisted therapy (RAT) at home for 30 consecutive days, after 2 therapist-supervised clinic on-boarding sessions. Web-based compliance measures were: accessed sessions of > 20 min/day, training minutes/day and active training hours/30 days. Clinical outcomes at weeks 0, 5 (post-training), 12 and 24 (follow-up) consisted of FMA, Action Research Arm Test (ARAT) and WHO-Stroke Specific Quality of Life (SSQOL). To estimate immediate economic benefits of the home-based robotic therapy, we performed cost-effectiveness analysis (CEA), followed by budget impact analysis (BIA). Results: Altogether, all 12 participants completed Home-RAT without adverse events; 9 (75.0%) were males, mean (SD) age, 59.4 years (9.5), median (IQR) stroke duration 38.6 weeks (25.4, 79.6) baseline FMA (0–66) 42.1 ± 13.2, ARAT (0–57) 25.4 ± 19.5, SSQOL (0–245) 185.3 ± 32.8. At week 5 follow-up, mean (SD) accessed days were 26.3 days ± 6.4, active training hours of 35.3 h ± 14.7/30 days, or ~ 6 days/week and 77 training minutes ± 20.9/day were observed. Significant gains were observed from baseline across time; ΔFMA 2.4 at week 5 (FMA 44.5, CI 95% 39.7–49.3, p < 0.05) and ΔFMA 3.7 at week 24 (FMA 45.8, CI 95% 40.5–51, p < 0.05); ΔARAT 2.6 at week 5 (ARAT 28.0, CI 95% 19.3–36.7, p < 0.05), and ΔARAT 4.8 at week 24 (ARAT 30.2, CI 95% 21.2–39.1, p < 0.05). At week 5 follow-up, 91% of participants rated their overall experience as satisfied or very satisfied. Incremental CEA observed savings of -S$144/per cure over 24 weeks, BIA—potentially 12% impact reduction over five years. Conclusions: This study demonstrates the feasibility, acceptability, safety, clinical efficacy, and cost-effectiveness of a home-based, web-enabled telemonitored carer-supervised robotics-aided therapy. Trial registration: NCT05212181 (https://clinicaltrials.gov). [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effectiveness of integrated personalized diabetes management (iPDM) through telemedicine (tele‐iPDM) with regard to glycaemic control. Methods: A 6‐month single‐centre, open‐label, prospective randomized controlled trial enrolled insulin‐treated patients with type 2 diabetes, aged 18–65 years with glycated haemoglobin (HbA1c) levels of 7.5%–10.5%. The tele‐iPDM group received insulin adjustment by investigators through a cloud‐based telemonitoring platform for 6 months (blood glucose monitoring reviewed weekly from Weeks 0 to 12 and then monthly from Weeks 13 to 24). The control group performed self‐monitoring and insulin adjustment. The primary outcome was the difference in HbA1c change from baseline between the two groups at 24 weeks. Secondary outcomes included changes in HbA1c at 12 weeks, fasting plasma glucose, body weight, body mass index (BMI), the percentage of individuals achieving HbA1c <7% at 24 weeks, the percentage of individuals with an HbA1c reduction of >0.5% at 24 weeks, and incidences of hypoglycaemic events. Results: A total of 151 participants were enrolled, with a mean age of 53.36 ± 8.08 years and a mean diabetes duration of 12.38 ± 8.47 years. The baseline HbA1c was 8.47 ± 0.76%. The mean HbA1c decreased from baseline to 12 and 24 weeks in both groups. At 12 weeks, HbA1c reduction from baseline was −1.2% (95%CI −1.42 to −0.98) in the tele‐iPDM group and −0.57% (95%CI −0.79 to −0.36) in the control group. The mean difference in HbA1c between the tele‐iPDM and usual care groups at 12 weeks was −0.63% (95%CI −0.94 to −0.32; p < 0.001). At 24 weeks, HbA1c reduction from baseline was −1.14% (95%CI −1.38 to −0.89) in the tele‐iPDM group and − 0.49% (95%CI −0.73 to −0.25) in the control group. The mean difference in HbA1c between the tele‐iPDM and usual care groups was −0.65% (95%CI −0.99 to −0.30; p < 0.001). There were no significant differences in body weight, BMI, or hypoglycaemic events between the two groups. Conclusion: Telemonitoring can support the iPDM care model in individuals with insulin‐treated type 2 diabetes. It improves the efficiency of diabetes care, enhances glycaemic control at 12 weeks, and sustains glycaemic control at 24 weeks. [ABSTRACT FROM AUTHOR]

Background: Considering time-consuming, cost-related limitations of laboratory-based HbA1c testing and follow-up clinic visits for diabetes management, it is important to explore alternative care models which incorporate point-of-care testing for HbA1c to monitor glycaemic control and related management. Methods: Therefore, we adopted an implementation perspective to conduct one group pre- and post-intervention feasibility pilot assessing feasibility, acceptability and satisfaction with conducting home HbA1c test by patients with type 2 diabetes coupled with telemonitoring and teleconsultations (i.e., the Primary Technology Enhanced Care (PTEC) Home HbA1c Testing (HAT) Programme) in Singaporean primary care setting. The secondary objective was to compare the HbA1c, blood pressure and primary care visits at the end or during intervention, vs. 6 months before. Adult patients with type 2 diabetes with HbA1c ≤ 8% without any diabetes complications and having phone compatibility were recruited. Data was collected via patient self-reports and electronic medical records extraction. While summary statistics and paired t-test were computed for quantitative data, open-ended feedback was analysed using content analysis. Results: A total of 33 participants completed the intervention out of 37 (33/37 = 89%) recruited from 73 eligible (37/73 = 51%). Most were either 51 to 60 years old (46.9%) or more than 60 years (37.5%), with more males (53.1%) and majority Chinese (93.8%). Majority (81.3%) felt that home HbA1c testing was beneficial with most commonly reported benefit of not having a clinic visit. A key finding was the average of diabetes-related visits being significantly lower post-intervention with comparable HbA1c values pre- and post-intervention. The most commonly reported challenge was using Bluetooth to transmit the reading (43.7%), followed by having too many steps to remember (28.1%). While participants reported being overall satisfied with the intervention, only 22% were willing to pay for it. Conclusion: Our findings support home HbA1c testing by patients coupled with telemonitoring and teleconsultations. Following are practical recommendations for the implementation scaling phase: offering PTEC HAT Programme to suitable patients who are self-motivated and have adequate digital literacy, provision of adequate educational and training support, sending reminders and exploring enabling manual submission of HbA1c readings considering Bluetooth-related challenges. [ABSTRACT FROM AUTHOR]

Respiratory allergic diseases affect over 500 million people globally and pose a substantial burden in terms of morbidity, mortality, and healthcare costs. Restrictive factors such as geographical disparities, infectious pandemics, limitations in resources, and shortages of allergy specialists in underserved areas impede effective management. Telemedicine encompasses real-time visits, store-and-forward option triage, and computer-based technologies for establishing efficient doctor-patient communication. Recent advances in digital technology, including designated applications, informative materials, digital examination devices, wearables, digital inhalers, and integrated platforms, facilitate personalized and evidence-based care delivery. The integration of telemonitoring in respiratory allergy care has shown beneficial effects on disease control, adherence, and quality of life. While the COVID-19 pandemic accelerated the adoption of telemedicine, certain concerns regarding technical requirements, platform quality, safety, reimbursement, and regulatory considerations remain unresolved. The integration of artificial intelligence (AI) in telemonitoring applications holds promise for data analysis, pattern recognition, and personalized treatment plans. Striking the balance between AI-enabled insights and human expertise is crucial for optimizing the benefits of telemonitoring. While telemonitoring exhibits potential for enhancing patient care and healthcare delivery, critical considerations have to be addressed in order to ensure the successful integration of telemonitoring into the healthcare landscape. [ABSTRACT FROM AUTHOR]

Background: Telementoring studies found technical challenges in achieving accurate and stable annotations during live surgery using commercially available telestration software intraoperatively. To address the gap, a wireless handheld telestration device was developed to facilitate dynamic user interaction with live video streams. Objective: This study aims to find the perceived usability, ergonomics, and educational value of a first-generation handheld wireless telestration platform. Methods: A prototype was developed with four core hand-held functions: (1) free-hand annotation, (2) cursor navigation, (3) overlay and manipulation (rotation) of ghost (avatar) instrumentation, and (4) hand-held video feed navigation on a remote monitor. This device uses a proprietary augmented reality platform. Surgeons and trainees were invited to test the core functions of the platform by performing standardized tasks. Usability and ergonomics were evaluated with a validated system usability scale and a 5-point Likert scale survey, which also evaluated the perceived educational value of the device. Results: In total, 10 people (9 surgeons and 1 senior resident; 5 male and 5 female) participated. Participants strongly agreed or agreed (SA/A) that it was easy to perform annotations (SA/A 9, 90% and neutral 0, 0%), video feed navigation (SA/A 8, 80% and neutral 1, 10%), and manipulation of ghost (avatar) instruments on the monitor (SA/A 6, 60% and neutral 3, 30%). Regarding ergonomics, 40% (4) of participants agreed or strongly agreed (neutral 4, 40%) that the device was physically comfortable to use and hold. These results are consistent with open-ended comments on the device's size and weight. The average system usability scale was 70 (SD 12.5; median 75, IQR 63-84) indicating an above average usability score. Participants responded favorably to the device's perceived educational value, particularly for postoperative coaching (agree 6, 60%, strongly agree 4, 40%). Conclusions: This study presents the preliminary usability results of a novel first-generation telestration tool customized for use in surgical coaching. Favorable usability and perceived educational value were reported. Future iterations of the device should focus on incorporating user feedback and additional studies should be conducted to evaluate its effectiveness for improving surgical education. Ultimately, such tools can be incorporated into pedagogical models of surgical coaching to optimize feedback and training. [ABSTRACT FROM AUTHOR]

Objectives: Noninvasive ventilation (NIV) is an effective treatment for chronic respiratory failure (CRF). Patient-centered outcomes need to be evaluated regularly and the S3-NIV questionnaire seems an applicable tool. We translated this short, self-administered questionnaire into a Dutch version and tested its construct validity and reliability. Methods: An observational study was conducted, including 127 stable long-term NIV users with CRF or complex sleep related breathing disorders due to different underlying diseases: chronic obstructive pulmonary disease (25%), slowly progressive neuromuscular disorders (35%), rapidly progressive neuromuscular disorders (12%) and 'other disorders' (28%) including complex sleep apnea and obesity hypoventilation syndrome. Construct validity and reliability were tested. Results: The Dutch version of the questionnaire was obtained after a translation and back-translation process. Internal consistency of the total score was good (Cronbach's α coefficient of 0.78) as well as for the 'respiratory symptoms' subdomain and the 'sleep and side effects' subdomain (Cronbach's α coefficient of 0.78 and 0.69, respectively). The reproducibility was excellent with an intraclass correlation of 0.89 (95% CI 0.87-0.93). Construct validity was good for the 'respiratory symptoms' subdomain. Conclusion: The Dutch S3-NIV questionnaire is a reliable and valid tool to evaluate symptoms, sleep, and NIV related side effects in long-term NIV users. [ABSTRACT FROM AUTHOR]

The present study introduces an innovative device designed to objectively record and quantify the daily standing profiles of individuals with lower limb motor impairment. The device is specifically developed to be seamlessly embedded onto the standing platform of an assistive standing mobile device, without compromising its structural integrity or functional capabilities. The primary objective of this device is to provide objective evidence of patients' standing activities within their home environment, thus facilitating the assessment of patient performance and usage. The embedded device captures and stores comprehensive data regarding the duration, frequency, and interval of patients' standing sessions. Furthermore, the device integrates wireless connectivity to facilitate data transfer and analysis. The development process involved close collaboration between rehabilitation engineers and physiotherapists to ensure optimal functionality, user-friendliness, and unobtrusiveness. Extensive testing and validation procedures were conducted to assess the reliability, validity, and feasibility of the device. The results demonstrate its high accuracy and reliability in capturing and quantifying standing profiles. The proposed device addresses a critical need within the field of rehabilitation, providing clinicians, researchers, and funding organizations with objective evidence of patients' standing abilities and adherence to rehabilitation protocols. This evidence-based approach has the potential to enhance clinical decision making, improve treatment outcomes, and secure financial support for patients in need of assistive standing mobile devices. In conclusion, the embedded device presented in this study offers a novel and practical solution for quantifying and recording the daily standing profiles of individuals with lower limb motor impairment. By providing objective evidence of patients' standing activities, this device has the potential to advance the field of rehabilitation and facilitate improved access to assistive standing mobile devices for those in need. [ABSTRACT FROM AUTHOR]

Background and aims: Congestion is a key driver of morbidity and mortality in heart failure. Implanted haemodynamic monitoring devices might allow early identification and management of congestion. Here, we provide a state-of-the-art review of implanted haemodynamic monitoring devices for patients with heart failure, including a meta-analysis of randomised trials. Methods and results: We did a systematic search for pre-print and published trials in Medline, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) on the 22nd of September 2021. We included randomised trials that compared management with or without information from implanted haemodynamic monitoring devices for patients with heart failure. Outcomes selected were hospitalisation for heart failure and all-cause mortality. Changes in treatment associated with haemodynamic monitoring resulted in only a small reduction in mean pulmonary artery pressure (typically < 1 mmHg as a daily average), which generally remained much greater than 20 mmHg. Haemodynamic monitoring reduced hospitalisations for heart failure (HR 0.75; 95% CI 0.58–0.96; p = 0.03) but not mortality (RR 0.92; 95% CI 0.68–1.26; p = 0.48). Conclusions: Haemodynamic monitoring for patients with heart failure may reduce the risk of hospitalization for heart failure but this has not yet translated into a reduction in mortality, perhaps because the duration of trials was too short or the reduction in pulmonary artery pressure was not sufficiently large. The efficacy and safety of aiming for larger reductions in pulmonary artery pressure should be explored. [ABSTRACT FROM AUTHOR]

Background: Home noninvasive positive pressure ventilation (NIPPV) has become evidence-based care for stable hypercapnic chronic obstructive pulmonary disease (COPD) patients. There are still other challenges including appropriate follow-up, telemonitor, and management to ensure treatment effectiveness, compliance, and security and to improve quality of life. The Internet of things (IOT) is the name given to the network of devices and other "things" with built-in sensors, software, electronics, and network connectivity, communicating these objects over wireless networks and sending data to a cloud platform. The study aims to evaluate the effectiveness and safety of the IOT-based management of NIPPV for the COPD patients with hypercapnic chronic respiratory failure. Methods: This multicenter, prospective, randomized controlled trial was conducted with a total of 200 COPD patients with chronic hypercapnic respiratory failure. Using a computer-generated randomization process, patients were randomized (in a 1:1 ratio) into the usual NIPPV (control group) or to receive additional IOT-based management (intervention group) for 12 months. The primary outcome was the Severe Respiratory Insufficiency (SRI) questionnaire. Secondary outcomes included compliance with the ventilator, gas exchange, lung function, health-related quality of life, hospitalization frequency, time to death within 1-year, all-cause mortality, safety analysis, and cost-effectiveness analysis. Discussion: This study will be the first and largest randomized trial in China to evaluate the effectiveness and safety of the IOT-based management of NIPPV for COPD patients with chronic hypercapnic respiratory failure. The results will help to understand the current situation of IOT-based home ventilation and may provide new evidence for home NIPPV treatment and management in the future. Trial registration: Chinese Clinical Trials Registry ChiCTR1800019536. Registered on 17 November 2018. [ABSTRACT FROM AUTHOR]

Background: Home noninvasive positive pressure ventilation (NIPPV) has become evidence-based care for stable hypercapnic chronic obstructive pulmonary disease (COPD) patients. There are still other challenges including appropriate follow-up, telemonitor, and management to ensure treatment effectiveness, compliance, and security and to improve quality of life. The Internet of things (IOT) is the name given to the network of devices and other "things" with built-in sensors, software, electronics, and network connectivity, communicating these objects over wireless networks and sending data to a cloud platform. The study aims to evaluate the effectiveness and safety of the IOT-based management of NIPPV for the COPD patients with hypercapnic chronic respiratory failure. Methods: This multicenter, prospective, randomized controlled trial was conducted with a total of 200 COPD patients with chronic hypercapnic respiratory failure. Using a computer-generated randomization process, patients were randomized (in a 1:1 ratio) into the usual NIPPV (control group) or to receive additional IOT-based management (intervention group) for 12 months. The primary outcome was the Severe Respiratory Insufficiency (SRI) questionnaire. Secondary outcomes included compliance with the ventilator, gas exchange, lung function, health-related quality of life, hospitalization frequency, time to death within 1-year, all-cause mortality, safety analysis, and cost-effectiveness analysis. Discussion: This study will be the first and largest randomized trial in China to evaluate the effectiveness and safety of the IOT-based management of NIPPV for COPD patients with chronic hypercapnic respiratory failure. The results will help to understand the current situation of IOT-based home ventilation and may provide new evidence for home NIPPV treatment and management in the future. Trial registration: Chinese Clinical Trials Registry ChiCTR1800019536. Registered on 17 November 2018. [ABSTRACT FROM AUTHOR]

Background and Objectives: In March 2020, COVID-19 pandemic affected the world. All countries, to limit viral transmission, imposed quarantine. This emergency exerted personal, social, economic, and psychological impact on people. For health systems, was needed to create alternative care pathways. Telemedicine can be helpful to reduce isolation, provide health care services, and monitor virus infections. Italian regions, including Sicily, have activated telemedicine services for management of patients with COVID-19. Objective: The purpose of study is to describe a Sicilian telemedicine model for management of COVID-19 patients, showing results on feasibility, usability and quality of service and patient satisfaction. Materials and Methods: This is a descriptive exploratory study on a telemedicine service for residents in Messina infected by COVID-19. It included monitoring of vital signs and specialist consultations (i.e., doctor, psychologists, social workers, and nutritionist biologists). Results: More than twenty percent (23.8%) of participants used tele-monitoring and tele-counselling services; 14.3% were only telemonitored. Participants judged positively telemedicine service (30% were quiet and 50% were very satisfied), as well as tool (70% were quiet and 10% were very satisfied). Telemonitoring had a low agreement (10% were slightly satisfied and 50% were neutral); tele-counselling had a high rate of satisfaction (40% quiet and 60% were very satisfied). Conclusions: This study showed that telemedicine model for Sicilian population affected by COVID-19 was feasible, easy to use and appreciated by patients. Our promising results allow us to assume that if in Sicily there was a return of the emergency, we would be ready to manage it This system can be the solution to remote management of these patients, to reduce isolation, provide health services, and monitor virus infections. The use of this technology should encourage future research to change the health care system and provides opportunities to ensure health and care for oneself and others. [ABSTRACT FROM AUTHOR]

Background: Home noninvasive positive pressure ventilation (NIPPV) has become evidence-based care for stable hypercapnic chronic obstructive pulmonary disease (COPD) patients. There are still other challenges including appropriate follow-up, telemonitor, and management to ensure treatment effectiveness, compliance, and security and to improve quality of life. The Internet of things (IOT) is the name given to the network of devices and other "things" with built-in sensors, software, electronics, and network connectivity, communicating these objects over wireless networks and sending data to a cloud platform. The study aims to evaluate the effectiveness and safety of the IOT-based management of NIPPV for the COPD patients with hypercapnic chronic respiratory failure.Methods: This multicenter, prospective, randomized controlled trial was conducted with a total of 200 COPD patients with chronic hypercapnic respiratory failure. Using a computer-generated randomization process, patients were randomized (in a 1:1 ratio) into the usual NIPPV (control group) or to receive additional IOT-based management (intervention group) for 12 months. The primary outcome was the Severe Respiratory Insufficiency (SRI) questionnaire. Secondary outcomes included compliance with the ventilator, gas exchange, lung function, health-related quality of life, hospitalization frequency, time to death within 1-year, all-cause mortality, safety analysis, and cost-effectiveness analysis.Discussion: This study will be the first and largest randomized trial in China to evaluate the effectiveness and safety of the IOT-based management of NIPPV for COPD patients with chronic hypercapnic respiratory failure. The results will help to understand the current situation of IOT-based home ventilation and may provide new evidence for home NIPPV treatment and management in the future.Trial Registration: Chinese Clinical Trials Registry ChiCTR1800019536 . Registered on 17 November 2018. [ABSTRACT FROM AUTHOR]

Copyright of Egitania Sciencia is the property of Egitania Sciencia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives Gout flares are painful and disabling. We developed a smartphone application (app) for patients to tele-monitor gout flares surveyed by clinicians. The aim of this study was to assess patient acceptability and technical and clinical feasibility. Methods Adult patients with either established gout or high suspicion thereof were recruited if they possessed a smartphone and reported a recent arthritis attack. A smartphone application was used to identify gout flares by asking during 90 consecutive days: (1) what is your pain score (0–10); (2) are your joints warm; (3) are your joints swollen; and (4) are you currently experiencing a gout flare? The clinician was alerted via email if a flare occurred. Patient acceptability was assessed using the technology acceptance model. Technical feasibility consisted of reported technical issues and clinical feasibility of actions taken by the clinician regarding gout flare alerts. Results Twenty-nine included patients completed the study. The mean age of participants was 57 years, and all but one were male. The adherence rate was 96% (110 of 2910 queries were missed). Patients had a positive attitude toward app use, found the app very easy to use (mean usability score 81 out of 100) and were neutral to positive on its usefulness. There were four minor technical issues. A total of 100 gout flare alerts were generated that led to 18 proactive contacts with patients. Conclusion A smartphone app to monitor gout flares was developed and tested, showing high adherence, good acceptability and clinical feasibility for established gout patients. Trial registration Netherlands Trial Register, https://www.trialregister.nl , NL6435. [ABSTRACT FROM AUTHOR]

Background: Regular supervision of patients with type-2 diabetes mellitus (T2DM) by healthcare providers is essential to optimise their glycaemic control but is challenging to achieve in current care models. Telemonitoring is postulated to bridge this gap by leveraging on internet-of-things and mobile-health technology. This study aims to determine the effectiveness of a novel telemonitoring system (OPTIMUM) in improving the glycaemic control of patients with T2DM compared with standard of care alone.Methods: This mixed-method study comprises an initial randomised controlled trial involving 330 Asian adults with T2DM, aged 26-65 years old with an HbA1c of 7.5-10%, with 115 in the intervention and control arms each. Those in the intervention arm will use standardised Bluetooth-enabled devices to transmit their capillary glucose, blood pressure and weight measurements to the OPTIMUM system. Primary care physicians and nurses will remotely supervise them according to an embedded management algorithm for 6 months, including tele-education via weekly videos over 8 weeks and asynchronous tele-consultation if abnormal or absent parameters are detected. Patients in both arms will be assessed at baseline, 6, 12 and 24 months post-recruitment. The primary outcome will be their HbA1c difference between both arms at baseline and 6 months. Blood pressure and weight control; quality of life, medication adherence, confidence in self-management, diabetic literacy and related distress and healthcare utilisation using validated questionnaires; and incident retinal, renal, cardiac and cerebrovascular complications will be compared between the two arms as secondary outcomes at stipulated time-points. Intervention arm patients will be interviewed using qualitative research methods to understand their experience, acceptance and perceived usefulness of the OPTIMUM system.Discussion: Overall, this study seeks to evaluate the effectiveness of cultural-adapted telemonitoring system in improving glycaemic control of Asians with type-2 diabetes mellitus compared to standard of care. The results of this trial will better inform policy makers in adopting telemedicine for population health management.Trial Registration: ClinicalTrials.gov NCT04306770 . Registered on March 13, 2020. [ABSTRACT FROM AUTHOR]

Copyright of Herz is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Tele-monitoring (TM) is remote monitoring of individuals via info-communication technology, enabling them and their relatives or care-providers to recognize their health status conveniently. TM will be successful only if the individuals, often patients with medical conditions, are willing to accept and adopt it in their daily lives. This study aimed to determine the prevalence of willingness of patients with type 2 diabetes mellitus (T2DM) and/or hypertension towards the use of TM, and the factors influencing their uptake.Methods: A cross-sectional survey was conducted at two public primary care clinics (polyclinics) in north-eastern Singapore, where TM had not been implemented. After the patients with T2DM and/or hypertension consented after fulfilling the eligibility criteria, they were first introduced to the concept of TM using pictogram and explanation by the investigators. Data on their demography, clinical parameters, technological literacy and acceptance of TM based on the Health Information Technology Acceptance Model (HITAM) were subsequently collected, computed, analyzed, followed by regression analyses to identify the factors associated with their willingness to use TM.Results: Among 1125 eligible multi-ethnic Asian patients approached, 899 of them completed the assisted questionnaire survey, yielding a response rate of 79.9%. Their mean age was 58 ± 8 years, females 51.3% and Chinese 69.3%. Overall, 53.0% of the patients were willing to use TM. Personal beliefs on technology (OR = 3.54, 95%CI = 2.50-4.50, p < 0.001), prior technology utility (OR = 3.18, 95%CI = 1.57-6.42, p = 0.001), Patient's requirements to be accompanied (OR = 1.48, 95% CI = 1.054-2.082, P = 0.03) Cost considerations (OR = 2.96, 95% CI = 2.257-3.388, P < 0.01) and technological literacy (OR = 2.77, 95%CI = 2.05-3.38, p < 0.001) were associated with willingness to use TM.Conclusion: Slightly over half of the patients were willing to use TM. Factors such as age, ethnicity, technological literacy, beliefs and previous utility of technology of the patients have to be addressed before implementing TM in primary care. [ABSTRACT FROM AUTHOR]

Hypertension is a key risk factor for cardiovascular disease. Currently, around a third of people with hypertension are undiagnosed, and of those diagnosed, around half are not taking antihypertensive medications. The World Health Organisation (WHO) estimates that high blood pressure directly or indirectly causes deaths of at least nine million people globally every year. Purpose of Review: In this review, we examine how emerging technologies might support improved detection and management of hypertension not only in the wider population but also within special population groups such as the elderly, pregnant women, and those with atrial fibrillation. Recent Findings: There is an emerging trend to empower patients to support hypertension screening and diagnosis, and several studies have shown the benefit of tele-monitoring, particularly when coupled with co-intervention, in improving the management of hypertension. Summary: Novel technology including smartphones and Bluetooth®-enabled tele-monitoring are evolving as key players in hypertension management and offer particular promise within pregnancy and developing countries. The most pressing need is for these new technologies to be properly assessed and clinically validated prior to widespread implementation in the general population. [ABSTRACT FROM AUTHOR]

Telehealth interventions are designed to facilitate the remote exchange of information and data between patients and health care providers, improving the quality and safety of the patients and increasing efficiency and cost-effectiveness of health care providers. The development of telecommunications and virtual technology allowed a number of telehealth systems to be applied in different health care areas. These technologies can provide an alternative monitoring and solutions for decreasing the hospital readmission rates for patients with congestive heart failure (CHF). In this paper, a systematic literature review regarding telemonitoring and its use in the management of patients with CHF is conducted. The result indicated a that standardized tele-monitoring design would reduce a length of hospitalization and re-hospitalization rate. The other factors that moderate the effectiveness of the telemonitoring intervention include quality of life, mortality rate, and disease-specific knowledge (health literacy). All these factors align with the consumer-centred principle of The Australian Safety and Quality Framework for Health Care. [ABSTRACT FROM AUTHOR]

This article presents the research and application of android smart phones to support tele-monitoring cardiovascular disease. The smart phones are more flexible and easier to carry than laptops. According to a report from Newzoo, by November 2017, 75% of smartphones in the worldwide installed with Android operating system. In this paper, the authors designed a system that combined hardware with applications android smart phones software for measuring Electrocardiogram (ECG) signal. The results shown that the convenience and the effect of the application of android smart phones in monitoring cardiovascular disease in particular and healthcare in general, as android smartphone are widely used throughout the world. [ABSTRACT FROM AUTHOR]

This article addresses the art of living in a technological culture as the active engagement with technomoral change. It argues that this engagement does not just take the form of overt deliberation. It shows in more modest ways as reflection-in-action, an experimental process in which new technology is fitted into existing practices. In this process challenged values are re-articulated in pragmatic solutions to the problem of working with new technology. This art of working with technology is also modest in the sense that it is not oriented to shaping one's own subjectivity in relation to technology. It emanates from human existence as relational and aims at securing good relationships. The argument will be developed in relation to a case study of the ways in which homecare workers engaged with the value of privacy, challenged by tele-monitoring technology that was newly introduced into their work. [ABSTRACT FROM AUTHOR]

Background: The efficacy of disease management programs in improving the outcome of heart failure patients remains uncertain and may vary across health systems. This study explores whether a countrywide disease management program is superior to usual care in reducing adverse health outcomes and improving well-being among community-dwelling adult patients with moderate-to-severe chronic heart failure who have universal access to advanced health-care services and technologies.Methods: In this multicenter open-label trial, 1,360 patients recruited after hospitalization for heart failure exacerbation (38%) or from the community (62%) were randomly assigned to either disease management or usual care. Disease management, delivered by multi-disciplinary teams, included coordination of care, patient education, monitoring disease symptoms and patient adherence to medication regimen, titration of drug therapy, and home tele-monitoring of body weight, blood pressure and heart rate. Patients assigned to usual care were treated by primary care practitioners and consultant cardiologists. The primary composite endpoint was the time elapsed till first hospital admission for heart failure exacerbation or death from any cause. Secondary endpoints included the number of all hospital admissions, health-related quality of life and depression during follow-up. Intention-to-treat comparisons between treatments were adjusted for baseline patient data and study center.Results: During the follow-up, 388 (56.9%) patients assigned to disease management and 387 (57.1%) assigned to usual care had a primary endpoint event. The median (range) time elapsed until the primary endpoint event or end of study was 2.0 (0-5.0) years among patients assigned to disease management, and 1.8 (0-5.0) years among patients assigned to usual care (adjusted hazard ratio, 0.908; 95% confidence interval, 0.788 to 1.047). Hospital admissions were mostly (70%) unrelated to heart failure. Patients assigned to disease management had a better health-related quality of life and a lower depression score during follow-up.Conclusions: This comprehensive disease management intervention was not superior to usual care with respect to the primary composite endpoint, but it improved health-related quality of life and depression. A disease-centered approach may not suffice to make a significant impact on hospital admissions and mortality in patients with chronic heart failure who have universal access to health care.Clinical Trial Registration: Clinicaltrials.gov identifier: NCT00533013 . Trial registration date: 9 August 2007. Initial protocol release date: 20 September 2007. [ABSTRACT FROM AUTHOR]

Information and Communication Technologies applied to health care and advances in sensor and data transmission technology allowed tele-medicine based programs of care also for patients with respiratory diseases. Different sensors, transmission devices and interventions are used in tele-medicine for some indications. Patients suffering from Chronic Obstructive Pulmonary Disease, asthma, neuromuscular diseases, ventilator assisted individuals and those undergoing pulmonary rehabilitation programs may benefit from this approach. The legal problems are still unsolved. Economic advantages for health care systems, though potentially high, are still poorly investigated. Despite the hopes, we need more evidence before this modality can be considered as a real progress in the management of patients with respiratory diseases. On one hand, these technologies can improve the care of patients with difficult access to services, particularly those in rural/remote areas, on the other hand, there is the risk that they will be used only to reduce standard services in health systems of developed countries. [ABSTRACT FROM AUTHOR]

Copyright of Sistemas & Telemática is the property of Universidad ICESI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Chronic Obstructive Pulmonary Disease (COPD) is a preventable, treatable, and slowly progressive disease, whose course is aggravated by a periodic worsening of symptoms and lung function lasting for several days. The development of home telemonitoring systems has made possible to collect symptoms and physiological data in electronic records, boosting the development of decision support systems (DSSs). Current DSSs work with physiological measurements collected by means of several measuring and communication devices as well as with symptoms gathered by questionnaires submitted to COPD subjects. However, this contrasts with the advices provided by the World Health Organization and the Global initiative for chronic Obstructive Lung Disease that recommend to avoid invasive or complex daily measurements. For these reasons this manuscript presents a DSS detecting the onset of worrisome events in COPD subjects. It uses the hearth rate and the oxygen saturation, which can be collected via a pulse oximeter. The DSS consists in a binary finite state machine, whose training stage allows a subject specific personalization of the predictive model, triggering warnings, and alarms as the health status evolves over time. The experiments on data collected from 22 COPD patients tele-monitored at home for six months show that the system recognition performance is better than the one achieved by medical experts. Furthermore, the support offered by the system in the decision-making process allows to increase the agreement between the specialists, largely impacting the recognition of the worrisome events. [ABSTRACT FROM AUTHOR]

Background: The emergence of coronavirus has led to unprecedented burden on the healthcare system. monitor early symptoms COVID-19 patients is crucial. The internet of things (IoT) is solution to combat this pandemic. IoT enabled healthcare system is helpful for monitoring of COVID-19 patients. Objective: Determine the infrastructure requirements of tele-monitoring systems based IoT to monitoring of COVID-19 patients. Material and Methods: A systematic search was performed on IEEE, Scopus, PubMed from January 2020 to September 2022. This study was using of keywords and MeSH terms terms associated with COVID-19 and IoT. The inclusion criteria were studies using IoT technology and measured the vital parameters and symptoms of COVID-19. Exclusion criteria were studies, did not use sensors or monitoring device. Results: Searching scientific databases, 86 articles were included in the study with evaluation of the articles. We found that body temperature and heart rate sensors were the most used with 83% and 38%, respectively. Sensors blood oxygen level, respiratory rate, cough rate, blood pressure are used in (32%), (18%), (15%), (13%) of the systems, respectively. in (41%) of the systems, machine learning algorithms have been used as decision making modules, and (30%) used the Python environment. Conclusion: Considering that fever is the most frequent symptom in patients with COVID-19, body temperature sensors were the most widely used. In addition, most of systems used mobile phones as the end-user device. For improved decision-making is recommended to integrate the machine learning modules. [ABSTRACT FROM AUTHOR]

Services making use of information and communication technology (ICT) are of potential interest to face the challenges of our aging society. Aim of this article is to describe the possible field of application for ICT-supported services in the management of older adults, in particular those with functional impairment. The current status of ICT-supported services is described and examples of how these services can be implemented in everyday practice are given. Upcoming technical solutions and future directions are also addressed. An ICT-supported service is not only the technological tool, but its combination with clinical purposes for which it is used and the way it is implemented in everyday care. Patient's satisfaction with ICT-supported services is moderate to good. Actual use of patients is higher than those of professionals but very variable. Frequency of use is positively related to clinical outcome. ICT offers a variety of opportunities for the treatment and prevention of frailty and functional decline. Future challenges are related to the intelligence of the systems and making the technologies even more unobtrusive and intuitive. [ABSTRACT FROM AUTHOR]

Introduction In this paper, we evaluated patients' perspectives on the use of a system for home tele-rehabilitation, designed for subjects with low computer literacy suffering hand impairment due to rheumatic diseases. Methods After a clinical trial assessing device effectiveness, the Psychosocial Impact of Assistive Devices Scale (PIADS), Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST) and Individually Prioritised Problem Assessment (IPPA) questionnaires were administered to evaluate the system's impact on each patient's life, and the results were correlated with clinical indices. Patients were asked to continue self-administered rehabilitation with common objects. One year later, a semi-structured telephone interview gathered data on their experience. Results The system received a positive QUEST score (4.5 ± 0.3) and a modest PIADS score (0.84 ± 0.8) due to the small impact on adaptability and self-esteem. The IPPA (3.7 ± 3.4) revealed improvement in the ability to perform tasks considered important, which was significantly correlated ( r = 0.60; p < 0.02) with the clinical Health Assessment Questionnaire (HAQ) index improvement. The interviews revealed a positive engagement effect, enhanced by the need to develop skills to be able to use the device (technological challenge) and by the perception of more attention by the medical staff. This may explain the significant dropout rate (80%) from the post-trial rehabilitation of the patients who used the device. Discussion The system was largely accepted by the patients. The results suggest that the need for information on their rehabilitation progress and the technological challenge deserves further study to make patients more autonomous in cases of continuous rehabilitation. [ABSTRACT FROM AUTHOR]

A novel service oriented platform has been developed under the framework of the Telerehabilitation Service funded by the Cross Border Cooperation Programme Greece Cyprus 2007 - 2013 to support tele-supervised exercise rehabilitation for patients after hospitalization in intensive care units (ICU). The platform enables multiparty, interregional bidirectional audio/visual communication between clinical practitioners and post-ICU patients. It also enables patient group-based vital sign real time monitoring, patients' clinical record bookkeeping, and individualized and group-based patient online exercise programs. The exercise programs intended for the service are based on successful cardiorespiratory rehabilitation programs, individualized and monitored by a multidisciplinary team. The eligibility study of former ICU patients to participate in such a service as well as a cost benefit analysis are presented to support the cost effectiveness of the telerehabilitation program in addition to the expected health benefits to a large proportion of former ICU patients. [ABSTRACT FROM AUTHOR]

We present a smartphone-based system for real-time tele-monitoring of physical activity in patients with chronic heart-failure (CHF). We recently completed a pilot study with 15 subjects to evaluate the feasibility of the proposed monitoring in the real world and examine its requirements, privacy implications, usability, and other challenges encountered by the participants and healthcare providers. Our tele-monitoring system was designed to assess patient activity via minute-by-minute energy expenditure (EE) estimated from accelerometry. In addition, we tracked relative user location via global positioning system (GPS) to track outdoors activity and measure walking distance. The system also administered daily surveys to inquire about vital signs and general cardiovascular symptoms. The collected data were securely transmitted to a central server where they were analyzed in real time and were accessible to the study medical staff to monitor patient health status and provide medical intervention if needed. Although the system was designed for tele-monitoring individuals with CHF, the challenges, privacy considerations, and lessons learned from this pilot study apply to other chronic health conditions, such as diabetes and hypertension, that would benefit from continuous monitoring through mobile-health (mHealth) technologies. [ABSTRACT FROM PUBLISHER]

Although recent advancements in technology have led to major transformations in healthcare services, the use of tele-monitoring in patient care is yet an emerging occurrence. This study examines factors that affect the adoption of video based remote treatment of senior patients in a tele-glaucoma project in a large hospital in Greece. Several themes emerge from the study encapsulating technical, usability, process, institutional, ethics and privacy, clinicians’ behaviour and patients’ demography related factors. The findings of the study showed that while the benefits of tele-monitoring service adoption were of foremost importance for doctors, usability and connectivity for enabling remote services was critical for its success. [ABSTRACT FROM AUTHOR]

Previous studies have shown that gait speed is an important measure of functional ability in the elderly. Continuous monitoring of the gait speed of older adults in their home environment may therefore allow the detection of changes in gait speed which could be predictive of health changes of the monitored person. In this study, a system consisting of multiple wall-mounted cameras that can automatically measure the time an older adult needs to cross a predefined transfer zone in the home environment is presented. The purpose of this study is the preliminary validation of the algorithm of the camera system which consists of several preprocessing steps and the automatic measurement of the transfer times. This validation is done through data collection in the homes of four older adults for periods varying from eight to twelve weeks. Trends in the measured transfer times are visualised and subsequently compared with the results of clinical assessments obtained during the acquisition period such as Timed-Get-Up-and-Go tests. The results indicate that it is possible to identify long-term trends in transfer times which can be indicative of adverse health-related events. [ABSTRACT FROM AUTHOR]

This paper proposes a compressive sensing (CS) method for multi-channel electroencephalogram (EEG) signals in Wireless Body Area Network (WBAN) applications, where the battery life of sensors is limited. For the single EEG channel case, known as the single measurement vector (SMV) problem, the Block Sparse Bayesian Learning-BO (BSBL-BO) method has been shown to yield good results. This method exploits the block sparsity and the intra-correlation (i.e., the linear dependency) within the measurement vector of a single channel. For the multichannel case, known as the multi-measurement vector (MMV) problem, the Spatio-Temporal Sparse Bayesian Learning (STSBL-EM) method has been proposed. This method learns the joint correlation structure in the multichannel signals by whitening the model in the temporal and the spatial domains. Our proposed method represents the multi-channels signal data as a vector that is constructed in a specific way, so that it has a better block sparsity structure than the conventional representation obtained by stacking the measurement vectors of the different channels. To reconstruct the multichannel EEG signals, we modify the parameters of the BSBL-BO algorithm, so that it can exploit not only the linear but also the non-linear dependency structures in a vector. The modified BSBL-BO is then applied on the vector with the better sparsity structure. The proposed method is shown to significantly outperform existing SMV and also MMV methods. It also shows significant lower compression errors even at high compression ratios such as 10:1 on three different datasets. [ABSTRACT FROM AUTHOR]

Background: Fast and accurate quality estimation of the electrocardiogram (ECG) signal is a relevant research topic that has attracted considerable interest in the scientific community, particularly due to its impact on tele-medicine monitoring systems, where the ECG is collected by untrained technicians. In recent years, a number of studies have addressed this topic, showing poor performance in discriminating between clinically acceptable and unacceptable ECG records. Methods: This paper presents a novel, simple and accurate algorithm to estimate the quality of the 12-lead ECG by exploiting the structure of the cross-covariance matrix among different leads. Ideally, ECG signals from different leads should be highly correlated since they capture the same electrical activation process of the heart. However, in the presence of noise or artifacts the covariance among these signals will be affected. Eigenvalues of the ECG signals covariance matrix are fed into three different supervised binary classifiers. Results and conclusion: The performance of these classifiers were evaluated using PhysioNet/CinC Challenge 2011 data. Our best quality classifier achieved an accuracy of 0.898 in the test set, while having a complexity well below the results of contestants who participated in the Challenge, thus making it suitable for implementation in current cellular devices. [ABSTRACT FROM AUTHOR]

Background: Fast and accurate quality estimation of the electrocardiogram (ECG) signal is a relevant research topic that has attracted considerable interest in the scientific community, particularly due to its impact on tele-medicine monitoring systems, where the ECG is collected by untrained technicians. In recent years, a number of studies have addressed this topic, showing poor performance in discriminating between clinically acceptable and unacceptable ECG records. Methods: This paper presents a novel, simple and accurate algorithm to estimate the quality of the 12-lead ECG by exploiting the structure of the cross-covariance matrix among different leads. Ideally, ECG signals from different leads should be highly correlated since they capture the same electrical activation process of the heart. However, in the presence of noise or artifacts the covariance among these signals will be affected. Eigenvalues of the ECG signals covariance matrix are fed into three different supervised binary classifiers. Results and conclusion: The performance of these classifiers were evaluated using PhysioNet/CinC Challenge 2011 data. Our best quality classifier achieved an accuracy of 0.898 in the test set, while having a complexity well below the results of contestants who participated in the Challenge, thus making it suitable for implementation in current cellular devices. [ABSTRACT FROM AUTHOR]

Copyright of Revista Ingeniare is the property of Universidad Libre Seccional Barranquilla and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

With the growing proportion of dependant people (ageing, disabled users), Tele-assistance and Tele-monitoring platforms will play a significant role to deliver an efficient and less-costly remote care in their assistive living environments. Sensor based technology would greatly contribute to get valuable information which should help to provide personalized access to the services available within their living spaces. However, current access control models remain unsuitable due to the lack of completeness, flexibility and adaptability to the user profile. In this paper, we propose a new access control model based on the user capabilities and behavior. This model is evaluated using the data sensed from our tele-monitoring platform in order to assist automatically the dependent people according to the occurred situation. The design of our model is a dynamic ontology and evolving security policy according to the access rules that are used in the inference engine to provide the right service according to the user's needs. Our security policy reacts according to the detected distress situation derived from the data combination of both the wearable devices and the pervasive sensors. The security policy is managed through the classification and reasoning process. Our classification process aims to extract the behavior patterns which are obtained by mining the data set issued from our Tele-monitoring platform according to the discriminating attributes: fall, posture, movement, time, user presence, pulse and emergency call. Our reasoning process aims to explore the recognized context and the extracted behavior patterns which set up the rule engine to infer the right decision security policy. [ABSTRACT FROM AUTHOR]

Physiological vital signs are important factors for clinical processes like tele-assessment, tele-monitoring and tele-treatment of patients. Records of patient vital signs over time are complex to understand without proper visualisation and data analysis aids. We present a model for interactively visualising vital signs in patient data histories, as used for remote chronic disease management. Our model allows simultaneous access to all vital signs records for the patient along a time-based axis. Clinicians and other health carers can then apply generalisation and refinement 'lenses' in a multi-layering visualisation mechanism to examine records further over single or multiple time sessions. The model also includes rule-based decisions for issuing notifications, when expected limits are exceeded. [ABSTRACT FROM AUTHOR]

Today microsystems are important for the prevention, diagnosis and therapy of diseases. Physicians use small endoscopes for minimally invasive surgery. Patients regain their mobility by high-tech prostheses equipped with several sensors and actuators. Intelligent implants such as pacemakers support existential functions. Cochlea-implants enable deaf persons to hear. Safe convalescence at home is possible by tele-monitoring devices. Point-of-care such as biochips supply quick diagnostic results. A number of these remarkable developments have been successfully supported by the German Federal Ministry of Education and Research (BMBF) since 1990. [ABSTRACT FROM AUTHOR]

Once the WHO declared the Sars-CoV-2 pandemic, the world had to reprogram numerous clinical activities, particularly those related to highly disabling diseases such as inflammatory bowel diseases (IBDs). In this study, 1083 IBD patients were assessed, affected by Crohn's Disease (CD) and Ulcerative Colitis (UC), and subdivided into two groups. The first group included patients who needed treatment in person at the outpatients clinic, while the second group could be tele-monitored because they were able to self-administer therapy. The tele-monitoring was based on telecommunication applications via smartphone, driven by a dedicated clinical control room in the IBD Clinic. The aim of this study was to assess the quality of life (using IBDQ32) of UC patients and tele-monitored CD patients (tele-monitoring group) as compared to those patients who underwent assessment in person in the outpatients clinic (control group). Despite observing a lower number of relapses in the control group than the tele-monitoring group, there were no statistically significant differences between the groups in terms of the IBD32Q scores. Tele-monitoring of patients who are able to self-administer the IBD therapy can be an effective vicarious system as compared to the clinical evaluation in person, that could lead to important changes to avoid the overcrowding of the IBD outpatients clinic, especially during public health crises like the present pandemic. [ABSTRACT FROM AUTHOR]

Prenatal monitoring of Fetal Heart Rate (FHR) is crucial for the prevention of fetal pathologies and unfavorable deliveries. However, the most commonly used Cardiotocographic exam can be performed only in hospital-like structures and requires the supervision of expert personnel. For this reason, a wearable system able to continuously monitor FHR would be a noticeable step towards a personalized and remote pregnancy care. Thanks to textile electrodes, miniaturized electronics, and smart devices like smartphones and tablets, we developed a wearable integrated system for everyday fetal monitoring during the last weeks of pregnancy. Pregnant women at home can use it without the need for any external support by clinicians. The transmission of FHR to a specialized medical center allows its remote analysis, exploiting advanced algorithms running on high-performance hardware able to obtain the best classification of the fetal condition. The system has been tested on a limited set of pregnant women whose fetal electrocardiogram recordings were acquired and classified, yielding an overall score for both accuracy and sensitivity over 90%. This novel approach can open a new perspective on the continuous monitoring of fetus development by enhancing the performance of regular examinations, making treatments really personalized, and reducing hospitalization or ambulatory visits. [ABSTRACT FROM AUTHOR]