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Internet-based home care has emerged as a way to relieve the burden of hospitals and meet patients' need for home care. This study aims to explore nurses' attitudes toward Internet-based home care. A cross-sectional online survey was conducted in Ningbo City in China. A self-designed Internet-based home care attitudes questionnaire for nurses (23 items) was used. There were 2039 nurses from 13 hospitals who participated in this online survey. Results reveal that, 1369 nurses (67.1%) were willing to provide Internet-based home care. However, there were significant differences in the attitudes of nurses with different ages (H = 11.86, P = .001), years of work experience (H = 24.257, P = .000), positions (H = 8.850, P = .031), and types of phones (H = 13.096, P = .001). More than 80% of nurses were willing to provide hypodermic and intramuscular injection. But there was a significant difference in the attitudes toward hypodermic injection, intramuscular injection, and pressure ulcer care in nurses with different ages (H = 13.039, P = .005; H = 9.178, P = .027; H = 10.997, P = .012) and a significant difference in the attitudes toward pressure ulcer care in nurses with different years of work experience (H = 15.259, P = .002). Results also indicated that most nurses were worried about their own safety and personal rights protection during Internet-based home care., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Despite the strong uptake of mobile health (mhealth) technology targeted at cardiovascular care, it is still unclear if this improves adherence to therapy and patient-related outcomes in those with established cardiovascular disease., Methods: A systematic search of English and Chinese language studies was conducted to investigate the benefit of mhealth technology for the secondary prevention of cardiovascular disease., Results: Twenty-seven studies with 5165 patients were included in the systematic review. Patients in the mhealth group showed increased adherence to medical therapy (odds ratio [OR], 4.51; P < 0.00001), as well as increased adherence to pharmacologic and nonpharmacologic therapy (OR, 3.86; P < 0.00001). Patients in the mhealth group showed the ability to meet recommended blood pressure targets (OR, 2.80; P < 0.001) with a trend toward the ability to meet exercise goals (OR, 2.55; P = 0.07), however, no significant difference in smoking cessation (OR, 1.42; P = 0.45) and the ability to meet lipid target levels (OR, 1.16; P = 0.29) was found. Patients in the mhealth group did not show a reduction in hospital readmission (OR, 0.93; P = 0.96), with a small number of studies showing a reduction in angina (OR, 0.23; P = 0.005), and a decrease in transient ischemic attack/stroke recurrence in those with cerebrovascular disease (OR, 0.18; P < 0.0001) and a trend toward lower observed mortality rate (OR, 0.19; P = 0.06)., Conclusions: The mhealth group compared with the usual care group had increased adherence to medical therapy, ability to reach blood pressure targets, exercise goals, and showed less anxiety and increased awareness of diet and exercise. There was no difference in smoking cessation, ability to meet low-density lipoprotein cholesterol targets, and hospital readmission., (Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.)

Wearable devices for biomedical instrumentation could generate the medical data and transmit to a repository on cloud service through wireless networks. In this process, the private medical data will be disclosed by man in the middle attack. Thus, the archived data for healthcare services would be protected by non-standardized security policy by healthcare service provider (HSP) because HIPAA only defines the security rules. In this paper, we adopted the Advanced Encryption Standard (AES) for security framework on wearable devices, so healthcare applications using this framework could support the confidentiality easily. The framework developed as dynamic loadable module targeted for lightweight microcontroller such as msp430 within embedded operating system. The performance was shown that the module can support the real-time encryption using electrocardiogram and photoplethysmogram. In this regard, the processing load for enabling security is distributed to wearable devices, and the customized data protection method could be composed by HSP for a trusted healthcare service.

We developed a telemedicine system for remote guidance of emergency airway management called the Tele-Airway Management System (TAMS). In a pilot study we examined the usefulness of the TAMS for intubations of actual patients in a hospital emergency department. Twenty-five patients were allocated randomly either to a TAMS group or to an on-scene directed (OSD) group. A total of 12 were intubated using the TAMS. The mean time to intubation (TAMS 62 s vs. OSD 56 s) and the success rate was not different between the two groups (P > 0.05). There were two oesophageal intubations in the TAMS group and four in the OSD group, but this was not significantly different (P = 0.36). There were no mechanical or technical errors such as disconnection during use of the TAMS. The pilot study demonstrated the feasibility of the TAMS as an alternative to OSD. However, a larger study will be required to determine non-superiority or equivalence.

A mobile telemedicine system, capable of transmitting video and audio simultaneously, was designed for consulting acute stroke patients remotely. It could use a wireless local area network (e.g. inside the hospital) or a mobile phone network (e.g. outside the hospital). When initiating a call, the sending unit chose a suitable encoding profile based on the measured data throughput, in order to allocate appropriate bit rates for video and audio transmission. The system was tested using a portable digital assistant (PDA) type phone and smart phone as receiving units. Video and audio recordings were made from five patients (two normal and three stroke patients) and then transmitted at different rates. Subjectively, both video and audio qualities improved as the data throughput increased. The physical findings, including facial droop, arm drift and abnormal speech, were observed remotely by four specialists according to the Cincinnati Pre-hospital Stroke Scale guideline. A comparison between the face-to-face method and the mobile telemedicine method showed that there were no discrepancies at bit rates of more than 400 kbit/s. We conclude that specialists could generally conduct remote consultations for stroke patients either using a public mobile network or a wireless LAN.

The telemedicine system aims at monitoring patients remotely without limit in time and space. However the existing telemedicine systems exchange medical information simply in a specified location. Due to increasing speed in processing data and expanding bandwidth of wireless networks, it is possible to perform telemedicine services on personal digital assistants (PDA). In this paper, a telemedicine system on PDA was developed using wideband mobile networks such as Wi-Fi, HSDPA, and WiBro for high speed bandwidths. This system enables to utilize and exchange variety and reliable patient information of video, biosignals, chatting messages, and triage data. By measuring bandwidths of individual data of the system over wireless networks, and evaluating the performance of this system using PDA, we demonstrated the feasibility of the designed portable emergency telemedicine system.

The reliable and instant transmission of vital signs is important for remote time-critical patient care through a telemedicine system. However, sometimes the reliability and instantaneity conditions cannot be satisfied simultaneously under a high-noise mobile network, because they are reciprocal to each other. In this paper, the vital sign transmission protocol (VSTP) running over a CDMA 1x EVDO (Code Division Multiple Access 1x Evolution Data Only) mobile network is proposed to comply with both the reliability and instantaneity requirements. The switching buffer management scheme is combined with a hybrid error control scheme, consisting of forward error correction (FEC) and automatic repeat request (ARQ). The CDMA 1x EVDO mobile network is modeled by two states using the Markov wireless channel model to test transmission performance under diverse network conditions. Throughout the noisy environment simulation, the performance of the VSTP is compared with the Transmission Control Protocol (TCP) and User Datagram Protocol (UDP) to demonstrate its efficacy over error-prone mobile network.

The use of wireless networks bears great practical importance in instantaneous transmission of ECG signals during movement. In this paper, three typical wavelet-based ECG compression algorithms, Rajoub (RA), Embedded Zerotree Wavelet (EZ), and Wavelet Transform Higher-Order Statistics Coding (WH), were evaluated to find an appropriate ECG compression algorithm for scalable and reliable wireless tele-cardiology applications, particularly over a CDMA network. The short-term and long-term performance characteristics of the three algorithms were analyzed using normal, abnormal, and measurement noise-contaminated ECG signals from the MIT-BIH database. In addition to the processing delay measurement, compression efficiency and reconstruction sensitivity to error were also evaluated via simulation models including the noise-free channel model, random noise channel model, and CDMA channel model, as well as over an actual CDMA network currently operating in Korea. This study found that the EZ algorithm achieves the best compression efficiency within a low-noise environment, and that the WH algorithm is competitive for use in high-error environments with degraded short-term performance with abnormal or contaminated ECG signals.

The delay performance of compression algorithms is particularly important when time-critical data transmission is required. In this paper, we propose a wavelet-based electrocardiogram (ECG) compression algorithm with a low delay property for instantaneous, continuous ECG transmission suitable for telecardiology applications over a wireless network. The proposed algorithm reduces the frame size as much as possible to achieve a low delay, while maintaining reconstructed signal quality. To attain both low delay and high quality, it employs waveform partitioning, adaptive frame size adjustment, wavelet compression, flexible bit allocation, and header compression. The performances of the proposed algorithm in terms of reconstructed signal quality, processing delay, and error resilience were evaluated using the Massachusetts Institute of Technology University and Beth Israel Hospital (MIT-BIH) and Creighton University Ventricular Tachyarrhythmia (CU) databases and a code division multiple access-based simulation model with mobile channel noise.

Continuous recording of daily symptoms constitutes an effective means of managing asthma patients. Daily management reduces the costs associated with hospitalization and improves the quality of patient care. We have implemented a Web-based mobile asthma management system. We used a pocket PC, mobile phone and desktop computer. The recorded items and individualized prescriptions were structured using Extensible Mark-up Language (XML) DTD (Data Type Definition). The mobile Web form was automatically adjusted to fit the different display resolutions of the terminal devices. The system provided reliable exchange of all relevant information between a doctor and the asthma patient using wireless mobile transmission. E-mail and Short Messaging Service (SMS) were used to send messages to patients, for example in the case of an automatically determined patient alert. Patients could obtain customized instructions according to their daily personal symptoms, peak expiratory flow (PEF), medications and activity restriction. The daily graph of PEF and the graphs of symptoms and medication were particularly useful for asthma patient control and self-awareness of the progress of the disease.

In this paper, an emergency telemedicine system was designed for the transmission of real-time multimedia for remote consultation, including radiological images, patient records, video-conferencing, full-quality video, ECG, BP, respiration, temperature, SpO(2), systolic and diastolic pressures and heart rate. The standardized, modular, software-based design architecture, without resorting to external hardware compression boards, enables the low-cost implementation of the telemedicine system, using the unified, systematic and compact integration of multimedia on general personal computers. Experimental tests on local networks analyze the technical aspects of designed systems, and inter-hospital experiments demonstrate its clinical usefulness.

We developed a telemedicine system for remote guidance of emergency airway management called the Tele-Airway Management System (TAMS). In a pilot study we examined the usefulness of the TAMS for intubations of actual patients in a hospital emergency department. Twenty-five patients were allocated randomly either to a TAMS group or to an on-scene directed (OSD) group. A total of 12 were intubated using the TAMS. The mean time to intubation (TAMS 62 s vs. OSD 56 s) and the success rate was not different between the two groups (P . 0.05). There were two oesophageal intubations in theTAMS group and four in the OSD group, but this was not significantly different (P ¼ 0.36). There were no mechanical or technical errors such as disconnection during use of the TAMS. The pilot study demonstrated the feasibility of the TAMS as an alternative to OSD. However, a larger study will be required to determine non-superiority or equivalence. [ABSTRACT FROM AUTHOR]

We tested three imaging devices for suitability in emergency dental situations for telemedicine. The three devices were a special-purpose oral camera, a digital single lens reflex (DSLR) camera, and the built-in camera of a mobile phone. A total of 20 subjects volunteered to take part in the study. We simulated five different conditions which could affect the quality of the image and measured image transmission times across two widely available mobile networks (a CDMA-based 3G network and a Wireless Broadband Network, WiBRO). The DSLR produced the best quality images, although it was a relatively large device and not easy to use. The oral camera failed to give satisfactory images under certain conditions (i.e. without extra lighting, out of focus and head motion). In contrast, the mobile phone based camera was very easy to use and to handle, and it gave good information for initial diagnosis, even at high compression ratios. If the image acquisition conditions are carefully set up, this device might be the best for emergency dental trauma situations. [ABSTRACT FROM AUTHOR]

We developed a Tele-Airway Management System (TAMS) which contained two high quality videocameras which were set up to view the frontal and lateral parts of the patient. Another endoscopic camera, a videolaryngoscope, was used to view the anatomy of the airway. One patient monitor was used to view the vital signs and there was also a PC terminal. A study was conducted in two separate emergency departments with 33 novice intubators (medical students and interns of the department). Remote consultation was provided by a board certified emergency physician. The time taken to complete endotracheal intubation for the TAMS group was 82.1 s (SE 4.9) and was 103.8 s (SE 7.9) in the videolaryngoscope-only group. The difference was significant (P = 0.03). The success rate of endotracheal intubation within 2 min was 94% for the TAMS group and 63% in the videolaryngoscope-only group (P = 0.04). With a wireless communication system, the TAMS could be installed in an ambulance, which might allow paramedics to perform safe and effective airway management in the field. [ABSTRACT FROM AUTHOR]

Multispecialist teleconsultation systems can be particularly useful in obtaining a second opinion from remote medical specialists. In this paper, a multispecialist teleconsultation (MST) system was designed by using multiple unicasting to enable operability over the existing Internet infrastructure and the support of reliable data transmission. The MST was tested over Asynchronous Digital Subscriber Line (ADSL), Very high speed Digital Subscriber Line (VDSL), Wireless Local Area Network (WLAN), and the hospital Local Area Network (LAN) to demonstrate the operability of the designed system over popularly deployed networks that together make up the current Internet. Also, subjective evaluation using induced delay and low quality video coding of sample brain surgery testing videos and two cases of clinical experimentations demonstrated the limiting factors of the MST in terms of quality and delay differences as well as the feasibility of the MST in a real clinical setting. [ABSTRACT FROM AUTHOR]

A Web-based, realtime, tele-ultrasound consultation system was designed. The system employed ActiveX control, MPEG-4 coding of full-resolution ultrasound video (640 × 480 pixels at 30 frames/s) and H.320 videoconferencing. It could be used via a Web browser. The system was evaluated over three types of commercial line: a cable connection, ADSL and VDSL. Three radiologists assessed the quality of compressed and uncompressed ultrasound video-sequences from 16 cases (10 abnormal livers, four abnormal kidneys and two abnormal gallbladders). The radiologists' scores showed that, at a given frame rate, increasing the bit rate was associated with increasing quality; however, at a certain threshold bit rate the quality did not increase significantly. The peak signal to noise ratio (PSNR) was also measured between the compressed and uncompressed images. In most cases, the PSNR increased as the bit rate increased, and increased as the number of dropped frames increased. There was a threshold bit rate, at a given frame rate, at which the PSNR did not improve significantly. Taking into account both sets of threshold values, a bit rate of more than 0.6 Mbit/s, at 30 frames/s, is suggested as the threshold for the maintenance of diagnostic image quality. [ABSTRACT FROM AUTHOR]

Video-encoders in telemedicine systems need to adjust their coding methods for operation on heterogeneous networks on which bandwidth fluctuates. We evaluated MPEG-4 compressed video-pictures of three trauma patients. We compared the original video-frames with compressed video-frames in terms of the peak signal-to-noise ratio (PSNR). In a qualitative evaluation, three emergency specialists scored the quality of the video-images blind, on a five-point scale (1= bad to 5 = excellent). The PSNR increased as the bit rate increased from 0.2 to 6 Mbit/s. When the bit rate was fixed, in other words at a given network bandwidth, a higher PSNR was obtained at the expense of spatial resolution and frame rate. The video quality was highly affected by the amount of camera shake. Emergency telemedicine systems require a high bit rate, high spatial resolution and a high frame rate to achieve optimum video quality. However, if the bandwidth is limited (i.e. the bit rate is fixed), temporal resolution becomes more important than spatial resolution. [ABSTRACT FROM AUTHOR]

Two different prototype mobile telemedicine systems were constructed for use in the emergency room. They could transmit physiological signals as well as video pictures and sound. One device, the mobile emergency bed (MEB), was powered by battery and had a wireless connection to the local-area network (LAN). For the other, the mobile emergency server (MES), a patient monitor, video-camera and microphone were connected by a radio-frequency link to a server. A functional evaluation and a clinical evaluation (by 12 emergency doctors in six emergency centres) were performed on both prototypes. The bandwidth and the video quality of the MEB were better than those of the MES, because of the digital transmission of the wireless LAN. The MES was better for directing patient treatment and teleconsultation; the MEB was better for static patients in the emergency centre. In general, the MES was more suitable for practical emergency telemedicine work. [ABSTRACT FROM AUTHOR]