International Journal of Telemedicine and Applications The latest articles from Hindawi Publishing Corporation © 2016 , Hindawi Publishing Corporation . All rights reserved. Software-Assisted Depth Analysis of Optic Nerve Stereoscopic Images in Telemedicine Thu, 14 Apr 2016 12:06:55 +0000 Background. Software guided optic nerve assessment can assist in process automation and reduce interobserver disagreement. We tested depth analysis software (DAS) in assessing optic nerve cup-to-disc ratio (VCD) from stereoscopic optic nerve images (SONI) of normal eyes. Methods. In a prospective study, simultaneous SONI from normal subjects were collected during telemedicine screenings using a Kowa 3Wx nonmydriatic simultaneous stereoscopic retinal camera (Tokyo, Japan). VCD was determined from SONI pairs and proprietary pixel DAS (Kowa Inc., Tokyo, Japan) after disc and cup contour line placement. A nonstereoscopic VCD was determined using the right channel of a stereo pair. Mean, standard deviation, -test, and the intraclass correlation coefficient (ICCC) were calculated. Results. 32 patients had mean age of years. Mean VCD on SONI was , with DAS , and with nonstereoscopic . The difference between stereoscopic and DAS assisted was not significant (). ICCC showed agreement between stereoscopic and software VCD assessment. Mean VCD difference was significant between nonstereoscopic and stereoscopic () and nonstereoscopic and DAS () recordings. Conclusions. DAS successfully assessed SONI and showed a high degree of correlation to physician-determined stereoscopic VCD. Tian Xia, Shriji N. Patel, Ben C. Szirth, Anton M. Kolomeyer, and Albert S. Khouri Copyright © 2016 Tian Xia et al. All rights reserved. A Multiple-Classifier Framework for Parkinson’s Disease Detection Based on Various Vocal Tests Tue, 12 Apr 2016 11:48:45 +0000 Recently, speech pattern analysis applications in building predictive telediagnosis and telemonitoring models for diagnosing Parkinson’s disease (PD) have attracted many researchers. For this purpose, several datasets of voice samples exist; the UCI dataset named “Parkinson Speech Dataset with Multiple Types of Sound Recordings” has a variety of vocal tests, which include sustained vowels, words, numbers, and short sentences compiled from a set of speaking exercises for healthy and people with Parkinson’s disease (PWP). Some researchers claim that summarizing the multiple recordings of each subject with the central tendency and dispersion metrics is an efficient strategy in building a predictive model for PD. However, they have overlooked the point that a PD patient may show more difficulty in pronouncing certain terms than the other terms. Thus, summarizing the vocal tests may lead into loss of valuable information. In order to address this issue, the classification setting must take what has been said into account. As a solution, we introduced a new framework that applies an independent classifier for each vocal test. The final classification result would be a majority vote from all of the classifiers. When our methodology comes with filter-based feature selection, it enhances classification accuracy up to 15%. Mahnaz Behroozi and Ashkan Sami Copyright © 2016 Mahnaz Behroozi and Ashkan Sami. All rights reserved. Towards mHealth Systems for Support of Psychotherapeutic Practice: A Qualitative Study of Researcher-Clinician Collaboration in System Design and Evaluation Tue, 01 Mar 2016 07:40:26 +0000 We examined clinicians’ and researchers’ experiences from participation in collaborative research on the introduction of Internet and mobile information systems (mHealth systems) in psychotherapeutic routines. The study used grounded theory methodology and was set in a collaboration that aimed to develop and evaluate mHealth support of psychotherapy provided to young people. Soundness of the central objects developed in the design phase (the collaboration contract, the trial protocol, and the system technology) was a necessary foundation for successful collaborative mHealth research; neglect of unanticipated organizational influences during the trial phase was a factor in collaboration failure. The experiences gained in this study can be used in settings where collaborative research on mHealth systems in mental health is planned. Karin Halje, Toomas Timpka, Joakim Ekberg, Magnus Bång, Anders Fröberg, and Henrik Eriksson Copyright © 2016 Karin Halje et al. All rights reserved. Effect of Reinforcement of Oral Health Education Message through Short Messaging Service in Mobile Phones: A Quasi-Experimental Trial Sun, 31 Jan 2016 15:23:11 +0000 Objective. This paper aims to assess the effectiveness of reinforcement of oral health education message through short messaging service (SMS) in mobile phones. Material and Methods. 400 subjects from two colleges (200 from each college) belonging to 18–20 years age group possessing mobile phones were randomly selected and baseline examination of oral hygiene and gingival status was carried out using Oral Hygiene Index (OHI) and Gingival Index (GI). Oral health education was provided to all the subjects. Oral health education message was reinforced through short messaging service (SMS) in mobile phones for the subjects belonging to the intervention group. There was no such reinforcement for the control group. Follow-up examinations were done at the end of 1st, 2nd, 3rd, and 6th month. After the 3rd month, subjects of the intervention group did not receive oral health education message through short messaging service (SMS) and were followed up after next three months. Compiled data was analyzed using SPSS version 16 statistical software. Result. Mean OHI and GI scores in intervention group were significantly () less than those of control group after the 2nd, 3rd, and 6th month. Conclusion. Reinforcement of oral health education message through short messaging service (SMS) is effective media to improve oral health. Harish C. Jadhav, Arun S. Dodamani, G. N. Karibasappa, Rahul G. Naik, Mahesh R. Khairnar, Manjiri A. Deshmukh, and Prashanth Vishwakarma Copyright © 2016 Harish C. Jadhav et al. All rights reserved. Tablet PC Enabled Body Sensor System for Rural Telehealth Applications Mon, 18 Jan 2016 16:34:30 +0000 Telehealth systems benefit from the rapid growth of mobile communication technology for measuring physiological signals. Development and validation of a tablet PC enabled noninvasive body sensor system for rural telehealth application are discussed in this paper. This system includes real time continuous collection of physiological parameters (blood pressure, pulse rate, and temperature) and fall detection of a patient with the help of a body sensor unit and wireless transmission of the acquired information to a tablet PC handled by the medical staff in a Primary Health Center (PHC). Abnormal conditions are automatically identified and alert messages are given to the medical officer in real time. Clinical validation is performed in a real environment and found to be successful. Bland-Altman analysis is carried out to validate the wrist blood pressure sensor used. The system works well for all measurements. Nitha V. Panicker and A. Sukesh Kumar Copyright © 2016 Nitha V. Panicker and A. Sukesh Kumar. All rights reserved. A Real-Time Health Monitoring System for Remote Cardiac Patients Using Smartphone and Wearable Sensors Tue, 15 Dec 2015 12:28:02 +0000 Online telemedicine systems are useful due to the possibility of timely and efficient healthcare services. These systems are based on advanced wireless and wearable sensor technologies. The rapid growth in technology has remarkably enhanced the scope of remote health monitoring systems. In this paper, a real-time heart monitoring system is developed considering the cost, ease of application, accuracy, and data security. The system is conceptualized to provide an interface between the doctor and the patients for two-way communication. The main purpose of this study is to facilitate the remote cardiac patients in getting latest healthcare services which might not be possible otherwise due to low doctor-to-patient ratio. The developed monitoring system is then evaluated for 40 individuals (aged between 18 and 66 years) using wearable sensors while holding an Android device (i.e., smartphone under supervision of the experts). The performance analysis shows that the proposed system is reliable and helpful due to high speed. The analyses showed that the proposed system is convenient and reliable and ensures data security at low cost. In addition, the developed system is equipped to generate warning messages to the doctor and patient under critical circumstances. Priyanka Kakria, N. K. Tripathi, and Peerapong Kitipawang Copyright © 2015 Priyanka Kakria et al. All rights reserved. Application of Fractional Wave Packet Transform for Robust Watermarking of Mammograms Mon, 02 Nov 2015 13:22:13 +0000 Exchanging of medical data requires efficient authentication and protection of medical data that can be illegally modified. Watermarking plays an important role in protecting, sharing, and securing medical data. In this work, a robust nonblind medical image watermarking scheme is proposed. The process involves two steps: the embedding and the extraction phase. During the embedding phase, l-level FRWPT is performed on the host image and the watermark is embedded into the modified reference image. In the second phase, inverse FRWPT is performed on the watermarked image to extract the watermark from the watermarked image. The proposed scheme is tested on mammograms images and is subjected to common attacks like Gaussian filtering, median filtering, compression, sharpening, and contrast adjustments. Experimental results show that the proposed scheme is robust. Pushpa Mala Siddaraju, Devappa Jayadevappa, and Kaliyamoorthy Ezhilarasan Copyright © 2015 Pushpa Mala Siddaraju et al. All rights reserved. Feasibility of Telerehabilitation Implementation as a Novel Experience in Rehabilitation Academic Centers and Affiliated Clinics in Tehran: Assessment of Rehabilitation Professionals’ Attitudes Wed, 28 Oct 2015 12:20:32 +0000 Introduction. This study aimed to assess rehabilitation professionals’ attitude toward implementation and application of telerehabilitation technology as a novel study in rehabilitation academic centers and affiliated clinics in Tehran. Methods. It was a descriptive cross-sectional study. To collect data, a researcher-designed questionnaire was developed. 141 rehabilitation experts participated in the study. Results. A majority of faculty members (78%) and clinicians (89.7%) either were in “definite agreement” or “somewhat agreed” with implementation and application of this technology, which demonstrates an overall positive attitude. Discussion. Based on the positive attitudes of the majority of participants toward implementation and application of this technology and their preferences in offering different telerehabilitation services, it seems that there is an appropriate and desirable acceptance and administrative culture to implement this technology among rehabilitation experts in Tehran. It is thus expected that implementation and application of this technology will be a promising experience in rehabilitation academic centers and affiliate clinics in Tehran. Sara Movahedazarhouligh, Roshanak Vameghi, Nikta Hatamizadeh, Enayatollah Bakhshi, and Seyed Muhammad Moosavy Khatat Copyright © 2015 Sara Movahedazarhouligh et al. All rights reserved. Willingness to Adopt Telemedicine in Major Iraqi Hospitals: A Pilot Study Thu, 08 Oct 2015 13:17:12 +0000 The Iraqi healthcare services are struggling to regain their lost momentum. Many physicians and nurses left Iraq because of the current situation in the country. Despite plans of calling back the skilled health workforce, they are still worried by the disadvantages of their return. Hence, technology plays a central role in taking advantage of their profession through the use of telemedicine. Studying the factors that affect the implementation of telemedicine is necessary. Telemedicine covers network services, policy makers, and patient understanding. A framework that includes the influencing factors in adopting telemedicine in Iraq was developed in this study. A questionnaire was distributed among physicians in Baghdad Medical City to examine the hypothesis on each factor. The Statistical Package for the Social Sciences was utilized to verify the reliability of the questionnaire and Cronbach’s alpha test shows that the factors have values more than 0.7, which are standard. Mohd Khanapi Abd Ghani and Mustafa Musa Jaber Copyright © 2015 Mohd Khanapi Abd Ghani and Mustafa Musa Jaber. All rights reserved. Impact of a Virtual Clinic in a Paediatric Cardiology Network on Northeast Brazil Tue, 21 Jul 2015 08:23:46 +0000 Introduction. Congenital heart diseases (CHD) affect approximately 1% of live births and is an important cause of neonatal morbidity and mortality. Despite that, there is a shortage of paediatric cardiologists in Brazil, mainly in the northern and northeastern regions. In this context, the implementation of virtual outpatient clinics with the aid of different telemedicine resources may help in the care of children with heart defects. Methods. Patients under 18 years of age treated in virtual outpatient clinics between January 2013 and May 2014 were selected. They were divided into 2 groups: those who had and those who had not undergone a screening process for CHD in the neonatal period. Clinical and demographic characteristics were collected for further statistical analysis. Results. A total of 653 children and teenagers were treated in the virtual outpatient clinics. From these, 229 had undergone a neonatal screening process. Fewer abnormalities were observed on the physical examination of the screened patients. Conclusion. The implementation of pediatric cardiology virtual outpatient clinics can have a positive impact in the care provided to people in areas with lack of skilled professionals. Juliana Sousa Soares de Araújo, Adalberto Vieira Dias Filho, Renata Grigório Silva Gomes, Cláudio Teixeira Regis, Klecida Nunes Rodrigues, Nicoly Negreiros Siqueira, Fernanda Cruz de Lira Albuquerque, Felipe Alves Mourato, and Sandra da Silva Mattos Copyright © 2015 Juliana Sousa Soares de Araújo et al. All rights reserved. Teleultrasound: Historical Perspective and Clinical Application Tue, 24 Feb 2015 11:54:11 +0000 The health care of patients in rural or isolated areas is challenged by the scarcity of local resources, limited patient access to doctors and hospitals, and the lack of specialized professionals. This has led to a new concept in telemedicine: teleultrasonography (or teleultrasound), which permits ultrasonographic diagnoses to be performed remotely. Telemedicine and teleultrasonography are effective in providing diagnostic imaging services to these populations and reduce health care costs by decreasing the number and duration of hospitalizations and reducing unnecessary surgical procedures. This is a narrative review to present the potential clinical applications of teleultrasonography in clinical practice. The results indicate that although barriers persist for implementing teleultrasonography in a more universal and routine way, advances in telecommunications, Internet bandwidth, and the high resolution currently available for portable ultrasonography suggest teleultrasonography applications will continue to expand. Teleultrasound appears to be a valuable addition to remote medical care for isolated populations with limited access to tertiary healthcare facilities and also a useful tool for education and training. Adilson Cunha Ferreira, Edward O’Mahony, Antonio Hélio Oliani, Edward Araujo Júnior, and Fabricio da Silva Costa Copyright © 2015 Adilson Cunha Ferreira et al. All rights reserved. Development of a Wearable-Sensor-Based Fall Detection System Mon, 16 Feb 2015 06:14:37 +0000 Fall detection is a major challenge in the public healthcare domain, especially for the elderly as the decline of their physical fitness, and timely and reliable surveillance is necessary to mitigate the negative effects of falls. This paper develops a novel fall detection system based on a wearable device. The system monitors the movements of human body, recognizes a fall from normal daily activities by an effective quaternion algorithm, and automatically sends request for help to the caregivers with the patient’s location. Falin Wu, Hengyang Zhao, Yan Zhao, and Haibo Zhong Copyright © 2015 Falin Wu et al. All rights reserved. Nurses’ Experience of Using an Application to Support New Parents after Early Discharge: An Intervention Study Wed, 28 Jan 2015 14:26:37 +0000 Background. A development towards earlier postnatal discharge presents a challenge to find new ways to provide information and support to families. A possibility is the use of telemedicine. Objective. To explore how using an app in nursing practice affects the nurses’ ability to offer support and information to postnatal mothers who are discharged early and their families. Design. Participatory design. An app with a chat, a knowledgebase, and automated messages was tried out between hospital and parents at home. Settings. The intervention took place on a postnatal ward with approximately 1,000 births a year. Participants. At the onset of the intervention, 17 nurses, all women, were working on the ward. At the end of the intervention, 16 nurses were employed, all women. Methods. Participant observation and two focus group interviews. The data analysis was inspired by systematic text condensation. Results. The nurses on the postnatal ward consider that the use of the app gives families easier access to timely information and support. Conclusions. The app gives the nurses the possibility to offer support and information to the parents being early discharged. The app is experienced as a lifeline that connects the homes of the new parents with the hospital. Dorthe Boe Danbjørg, Lis Wagner, Bjarne Rønde Kristensen, and Jane Clemensen Copyright © 2015 Dorthe Boe Danbjørg et al. All rights reserved. Improving Perinatal Care in the Rural Regions Worldwide by Wireless Enabled Antepartum Fetal Monitoring: A Demonstration Project Mon, 26 Jan 2015 13:55:35 +0000 Background. Fetal and neonatal morbidity and mortality are significant problems in developing countries; remote maternal-fetal monitoring offers promise in addressing this challenge. The Gary and Mary West Health Institute and the Instituto Carlos Slim de la Salud conducted a demonstration project of wirelessly enabled antepartum maternal-fetal monitoring in the state of Yucatán, Mexico, to assess whether there were any fundamental barriers preventing deployment and use. Methods. Following informed consent, high-risk pregnant women at 27–29 weeks of gestation at the Chemax primary clinic participated in remote maternal-fetal monitoring. Study participants were randomized to receive either prototype wireless monitoring or standard-of-care. Feasibility was evaluated by assessing technical aspects of performance, adherence to monitoring appointments, and response to recommendations. Results. Data were collected from 153 high-risk pregnant indigenous Mayan women receiving either remote monitoring () or usual standard-of-care (). Remote monitoring resulted in markedly increased adherence (94.3% versus 45.1%). Health outcomes were not statistically different in the two groups. Conclusions. Remote maternal-fetal monitoring is feasible in resource-constrained environments and can improve maternal compliance for monitoring sessions. Improvement in maternal-fetal health outcomes requires integration of such technology into sociocultural context and addressing logistical challenges of access to appropriate emergency services. Roberto Tapia-Conyer, Shelley Lyford, Rodrigo Saucedo, Michael Casale, Hector Gallardo, Karen Becerra, Jonathan Mack, Ricardo Mujica, Daniel Estrada, Antonio Sanchez, Ramon Sabido, Carlos Meier, and Joseph Smith Copyright © 2015 Roberto Tapia-Conyer et al. All rights reserved. Feasibility and Acceptability of Utilizing a Smartphone Based Application to Monitor Outpatient Discharge Instruction Compliance in Cardiac Disease Patients around Discharge from Hospitalization Thu, 11 Dec 2014 00:10:27 +0000 The purpose of this study was to determine the feasibility and acceptability of utilizing a smartphone based application to monitor compliance in patients with cardiac disease around discharge. For 60 days after discharge, patients’ medication compliance, physical activity, follow-up care, symptoms, and reading of education material were monitored daily with the application. 16 patients were enrolled in the study (12 males, 4 females, age 55 ± 18 years) during their hospital stay. Five participants were rehospitalized during the study and did not use the application once discharged. Seven participants completed 1–30 days and four patients completed >31 days. For those 11 patients, medication reminders were utilized 37% (1–30-day group) and 53% (>31-day group) of the time, education material was read 44% (1–30) and 53% (>31) of the time, and physical activity was reported 25% (1–30) and 42% (>31) of the time. Findings demonstrated that patients with stable health utilized the application, even if only minimally. Patients with decreased breath sounds by physical exam and who reported their health as fair to poor on the day of discharge were less likely to utilize the application. Acceptability of the application to report health status varied among the stable patients. Aimee M. Layton, James Whitworth, James Peacock, Matthew N. Bartels, Patricia A. Jellen, and Byron M. Thomashow Copyright © 2014 Aimee M. Layton et al. All rights reserved. Scheduling in Sensor Grid Middleware for Telemedicine Using ABC Algorithm Wed, 03 Dec 2014 12:05:19 +0000 Advances in microelectromechanical systems (MEMS) and nanotechnology have enabled design of low power wireless sensor nodes capable of sensing different vital signs in our body. These nodes can communicate with each other to aggregate data and transmit vital parameters to a base station (BS). The data collected in the base station can be used to monitor health in real time. The patient wearing sensors may be mobile leading to aggregation of data from different BS for processing. Processing real time data is compute-intensive and telemedicine facilities may not have appropriate hardware to process the real time data effectively. To overcome this, sensor grid has been proposed in literature wherein sensor data is integrated to the grid for processing. This work proposes a scheduling algorithm to efficiently process telemedicine data in the grid. The proposed algorithm uses the popular swarm intelligence algorithm for scheduling to overcome the NP complete problem of grid scheduling. Results compared with other heuristic scheduling algorithms show the effectiveness of the proposed algorithm. T. Vigneswari and M. A. Maluk Mohamed Copyright © 2014 T. Vigneswari and M. A. Maluk Mohamed. All rights reserved. Identification of Ocular and Auditory Manifestations of Congenital Rubella Syndrome in Mbingo Tue, 25 Nov 2014 11:54:23 +0000 Purpose. Congenital rubella syndrome (CRS) is a global cause of preventable hearing impairment, blindness, and intellectual impairment. The present study sought to identify ocular and auditory manifestations of CRS in school-aged children in Mbingo, Cameroon. Design. Cross sectional study. Subjects. Students at two schools, one for children with hearing impairment, were screened for cataract, congenital glaucoma, and pigmentary retinopathy. Methods. Students underwent seven-field digital fundus photography through a dilated pupil using a Topcon NW200 nonmydriatic camera. Images were assessed by retina specialists in Canada via teleophthalmology. Clinical evidence was integrated to form case definitions for CRS based on Center for Disease Control and Prevention guidelines. Serological evidence of rubella infection was obtained using standardized IgG antibody titers. Main Outcome Measure. Number of probable and suspicious cases of CRS. Results. Between September 2009 and May 2010, 320 students participated. There were 28 (10.2%) probable cases, 104 (37.8%) suspects, and 143 (52.0%) unaffected. Rubella IgG serology was positive in 79 (48.7%) of children with hearing impairment and 11 (7.4%) of children with normal hearing. Conclusions. The present study identified 28 probable cases of CRS. Furthermore, 92.6% of students with normal hearing did not possess rubella IgG antibodies making future cases of CRS likely without intervention. Imran Jivraj, Chris J. Rudnisky, Emmanuel Tambe, Graham Tipple, and Matthew T. S. Tennant Copyright © 2014 Imran Jivraj et al. All rights reserved. Health-Related Quality of Life of Rural Clients Seeking Telepsychology Services Wed, 19 Nov 2014 07:33:28 +0000 Sixty million US residents live in rural areas, but health policies and interventions developed from an urban mindset often fail to address the significant barriers to health experienced by these local communities. Telepsychology, or psychological services delivered by distance via technology, is an emerging treatment modality with special implications for underserved rural areas. This study found that a sample of rural residents seeking telepsychology services had low health-related quality of life (HRQOL), often due to cooccurring physical and mental health diagnoses including high rates of depression. However, a brief telepsychology treatment delivered to rural clients was associated with an improvement in mental health-related quality of life . These results indicate that despite the complex health needs of these underserved communities, telepsychology interventions may help offset the disparities in health service access in rural areas. Kevin R. Tarlow, Carly E. McCord, Timothy R. Elliott, and Daniel F. Brossart Copyright © 2014 Kevin R. Tarlow et al. All rights reserved. Telecardiology Application in Jordan: Its Impact on Diagnosis and Disease Management, Patients’ Quality of Life, and Time- and Cost-Savings Mon, 27 Oct 2014 00:00:00 +0000 Objectives. To assess the impact of live interactive telecardiology on diagnosis and disease management, patients’ quality of life, and time- and cost-savings. Methods. All consecutive patients who attended or were referred to the teleclinics for suspected cardiac problems in two hospitals in remote areas of Jordan during the study period were included in the study. Patients were interviewed for relevant information and their quality of life was assessed during the first visit and 8 weeks after the last visit. Results. A total of 76 patients were included in this study. Final diagnosis and treatment plan were established as part of the telecardiology consultations in 71.1% and 77.3% of patients, respectively. Patients’ travel was avoided for 38 (50.0%) who were managed locally. The majority of patients perceived that the visit to the telecardiology clinic results in less travel time (96.1%), less waiting time (98.1%), and lower cost (100.0%). Telecardiology consultations resulted in an improvement in the quality of life after two months of the first visit. Conclusions. Telecardiology care in remote areas of Jordan would improve the access to health care, help to reach proper diagnosis and establish the treatment plan, and improve the quality of life. Yousef Saleh Khader, Mohamad Ismail Jarrah, Abde-Ellah M. Al-Shudifat, Amjad Shdaifat, Husham Aljanabi, Shadwan Ismeil Al-Fakeh, Elias Emil Turk, Khaled Ali Zayed, Hanadi A. Al Quran, Ziad Mohd Ellauzi, and Mohammad Al Tahan Copyright © 2014 Yousef Saleh Khader et al. All rights reserved. Application of Handheld Tele-ECG for Health Care Delivery in Rural India Sun, 28 Sep 2014 09:05:28 +0000 Telemonitoring is a medical practice that involves remotely monitoring patients who are not at the same location as the health care provider. The purpose of our study was to use handheld tele-electrocardiogram (ECG) developed by Bhabha Atomic Research Center (BARC) to identify heart conditions in the rural underserved population where the doctor-patient ratio is low and access to health care is difficult. The objective of our study was clinical validation of handheld tele-ECG as a screening tool for evaluation of cardiac diseases in the rural population. ECG was obtained in 450 individuals (mean age 31.49 ± 20.058) residing in the periphery of Chandigarh, India, from April 2011 to March 2013, using the handheld tele-ECG machine. The data were then transmitted to physicians in Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, for their expert opinion. ECG was interpreted as normal in 70% individuals. Left ventricular hypertrophy (9.3%) was the commonest abnormality followed closely by old myocardial infarction (5.3%). Patient satisfaction was reported to be ~95%. Thus, it can be safely concluded that tele-ECG is a portable, cost-effective, and convenient tool for diagnosis and monitoring of heart diseases and thus improves quality and accessibility, especially in rural areas. Meenu Singh, Amit Agarwal, Vineet Sinha, Rohit Manoj Kumar, Nishant Jaiswal, Ishita Jindal, Pankaj Pant, and Munish Kumar Copyright © 2014 Meenu Singh et al. All rights reserved. Medical Image Watermarking Technique for Accurate Tamper Detection in ROI and Exact Recovery of ROI Wed, 24 Sep 2014 05:45:18 +0000 In telemedicine while transferring medical images tampers may be introduced. Before making any diagnostic decisions, the integrity of region of interest (ROI) of the received medical image must be verified to avoid misdiagnosis. In this paper, we propose a novel fragile block based medical image watermarking technique to avoid embedding distortion inside ROI, verify integrity of ROI, detect accurately the tampered blocks inside ROI, and recover the original ROI with zero loss. In this proposed method, the medical image is segmented into three sets of pixels: ROI pixels, region of noninterest (RONI) pixels, and border pixels. Then, authentication data and information of ROI are embedded in border pixels. Recovery data of ROI is embedded into RONI. Results of experiments conducted on a number of medical images reveal that the proposed method produces high quality watermarked medical images, identifies the presence of tampers inside ROI with 100% accuracy, and recovers the original ROI without any loss. R. Eswaraiah and E. Sreenivasa Reddy Copyright © 2014 R. Eswaraiah and E. Sreenivasa Reddy. All rights reserved. The Emerging Role of Telemedicine in Managing Glycemic Control and Psychobehavioral Aspects of Pregnancy Complicated by Diabetes Wed, 10 Sep 2014 09:18:38 +0000 There is a gradual decline in concern of specialists who follow up the care of pregnant women with diabetes. In addition, due to the dwindling economic resources allocated to health services, access to specialized healthcare facilities is becoming more difficult. Telemedicine, or medicine practiced at a distance, is inserted in this context with applications differing for type of interaction (real-time or deferred, i.e., videoconferencing versus store-and-forward data transmission), type of monitoring (automatic versus requesting cooperation from the patient), and type of devices used (web connections and use of mobile phones or smartphones). Telemedicine can cope with the current lack of ability to ensure these patients frequent direct contact with their caregivers. This approach may have an impact not only on the classical maternal-fetal outcome, but also on some underestimated aspects of patients with diabetes in pregnancy, in this case their quality of life, the perception of “diabetes self-efficacy,” and the glycemic variability. In this paper, we will analyze the current evidence regarding the use of telemedicine in pregnancies complicated by diabetes, trying to highlight the main limitations of these studies and possible strategies to overcome them in order to improve the effectiveness of future clinical interventions with these medical applications. Nino Cristiano Chilelli, Maria Grazia Dalfrà, and Annunziata Lapolla Copyright © 2014 Nino Cristiano Chilelli et al. All rights reserved. Patients’ Experiences with Specialist Care via Video Consultation in Primary Healthcare in Rural Areas Sun, 24 Aug 2014 00:00:00 +0000 Introduction. Video consultation (VC) can improve access to specialist care, especially for individuals who live in rural areas that are long distances from specialist clinics. Aim. The aim of this study was to describe patients’ experiences with specialist care via VC encounters. Method. Interviews were conducted with 26 patients who had participated in a VC encounter. The data were analysed using thematic content analysis. Result. The analysis resulted in two themes. The theme “confident with the technology” was constructed from the categories “possibilities and obstacles in using VC encounters” and “advantages and disadvantages of the technology.” The theme “personal satisfaction with the VC encounters” was constructed from the categories “support from the healthcare personnel,” “perceived security,” and “satisfaction with the specialist consultation.” Conclusion. The patients who did not think that the VC was the best care still considered that the visit was adequate because they did not have to travel. An important finding was that the patients’ perceived even short distances to specialty care as expensive journeys because many patients had low incomes. Among the patients who had more than one VC, the second encounter was perceived as safer. Additionally, good communication was essential for the patient’s perception of security during the VC encounter. Annette M. Johansson, Inger Lindberg, and Siv Söderberg Copyright © 2014 Annette M. Johansson et al. All rights reserved. An Android-Based Heart Monitoring System for the Elderly and for Patients with Heart Disease Tue, 19 Aug 2014 08:45:40 +0000 The current trend in health monitoring systems is to move from the hospital to portable personal devices. This work shows how consumer devices like heart rate monitors can be used not only for applications in sports, but also for medical research and diagnostic purposes. The goal pursued by our group was to develop a simple, accurate, and inexpensive system that would use a few pieces of data acquired by the heart rate monitor and process them on a smartphone to (i) provide detailed test reports about the user’s health state; (ii) store report records; (iii) generate emergency calls or SMSs; and (iv) connect to a remote telemedicine portal to relay the data to an online database. The system developed by our team uses sophisticated algorithms to detect stress states, detect and classify arrhythmia events, and calculate energy consumption. It is suitable for use by elderly subjects and by patients with heart disease (e.g., those recovering from myocardial infarction) or neurological conditions such as Parkinson’s disease. Easy, immediate, and economical remote health control can therefore be achieved without the need for expensive hospital equipment, using only portable consumer devices. Paola Pierleoni, Luca Pernini, Alberto Belli, and Lorenzo Palma Copyright © 2014 Paola Pierleoni et al. All rights reserved. An ICT-Based Diabetes Management System Tested for Health Care Delivery in the African Context Thu, 17 Jul 2014 06:35:44 +0000 The demand for new healthcare services is growing rapidly. Improving accessibility of the African population to diabetes care seems to be a big challenge in most countries where the number of care centers and medical staff is reduced. Information and communication technologies (ICT) have great potential to address some of these challenges faced by several countries in providing accessible, cost-effective, and high-quality health care services. This paper presents the Mobil Diab system which is a telemedical approach proposed for the management of long-term diseases. The system applies modern mobile and web technologies which overcome geographical barriers, and increase access to health care services. The idea of the system is to involve patients in the therapy process and motivate them for an active participation. For validation of the system in African context, a trial was conducted in the Democratic Republic of Congo. 40 Subjects with diabetes divided randomly into control and intervention groups were included in the test. Results show that Mobil Diab is suitable for African countries and presents a number of benefits for the population and public health care system. It improves clinical management and delivery of diabetes care services by enhancing access, quality, motivation, reassurance, efficiency, and cost-effectiveness. Claude Takenga, Rolf-Dietrich Berndt, Olivier Musongya, Joël Kitero, Remi Katoke, Kakule Molo, Basile Kazingufu, Malikwisha Meni, Mambo Vikandy, and Henri Takenga Copyright © 2014 Claude Takenga et al. All rights reserved. Online Medicine for Pregnant Women Sun, 13 Jul 2014 07:49:33 +0000 Objective. To assess the use of cell phones and email as means of communication between pregnant women and their gynecologists and family physicians. Study Design. A cross-sectional study of pregnant women at routine followup. One hundred and twenty women participated in the study. Results. The mean age was 27.4 ± 3.4 years. One hundred nineteen women owned a cell phone and 114 (95%) had an email address. Seventy-two women (60%) had their gynecologist's cell phone number and 50 women (42%) had their family physician’s cell phone number. More women contacted their gynecologist via cell phone or email during pregnancy compared to their family physician ( and 0.009, resp.). Most preferred to communicate with their physician via cell phone at predetermined times, but by email at any time during the day (). They would use cell phones for emergencies or unusual problems but preferred email for other matters (). Conclusions. Pregnant women in the Negev region do not have a preference between the use of cell phones or email for medical consultation with their gynecologist or family physician. The provision of the physician’s cell phone numbers or email address together with the provision of guidelines and resources could improve healthcare services. Sharon Davidesko, David Segal, and Roni Peleg Copyright © 2014 Sharon Davidesko et al. All rights reserved. Increasing Physical Activity Efficiently: An Experimental Pilot Study of a Website and Mobile Phone Intervention Thu, 22 May 2014 08:07:46 +0000 The main objective of this pilot study was to test the effectiveness of an online, interactive physical activity intervention that also incorporated gaming components. The intervention design included an activity planner, progress monitoring, and gamification components and used SMS text as a secondary delivery channel and feedback to improve engagement in the intervention content. Healthy adults (n=21) recruited through ads in local newspapers (age 35–73) were randomized to the intervention or the control condition. Both groups reported physical activity using daily report forms in four registration weeks during the three-month study: only the experiment condition received access to the intervention. Analyses showed that the intervention group had significantly more minutes of physical activity in weeks five and nine. We also found a difference in the intensity of exercise in week five. Although the intervention group reported more minutes of physical activity at higher intensity levels, we were not able to find a significant effect at the end of the study period. In conclusion, this study adds to the research on the effectiveness of using the Internet and SMS text messages for delivering physical activity interventions and supports gamification as a viable intervention tool. Kjærsti Thorsteinsen, Joar Vittersø, and Gunnvald Bendix Svendsen Copyright © 2014 Kjærsti Thorsteinsen et al. All rights reserved. Usability Study of a Wireless Monitoring System among Alzheimer’s Disease Elderly Population Tue, 20 May 2014 08:57:44 +0000 Healthcare technologies are slowly entering into our daily lives, replacing old devices and techniques with newer intelligent ones. Although they are meant to help people, the reaction and willingness to use such new devices by the people can be unexpected, especially among the elderly. We conducted a usability study of a fall monitoring system in a long-term nursing home. The subjects were the elderly with advanced Alzheimer’s disease. The study presented here highlights some of the challenges faced in the use of wearable devices and the lessons learned. The results gave us useful insights, leading to ergonomics and aesthetics modifications to our wearable systems that significantly improved their usability and acceptance. New evaluating metrics were designed for the performance evaluation of usability and acceptability. Stefano Abbate, Marco Avvenuti, and Janet Light Copyright © 2014 Stefano Abbate et al. All rights reserved. Using Action Research and Peer Perspectives to Develop Technology That Facilitates Behavioral Change and Self-Management in COPD Sun, 18 May 2014 08:50:29 +0000 Background. Behavioural change and self-management in patients with chronic illness may help to control symptoms, avoid rehospitalization, enhance quality of life, and decrease mortality and morbidity. Objective. Guided by action research principles and using mixed methods, the aim of this project was to develop peer based educational, motivational, and health-promoting peer based videos, using behavioural change principles, to support self-management in patients with COPD. Methods. Individuals living with COPD at home and involved in two community based COPD support groups were invited to participate in this project. Focus group/individual interviews and a demographic questionnaire were used to collect data. Results. Analysis revealed 6 categories relevant to behavioural change which included self-management, support, symptoms, knowledge, rehabilitation, and technology. Participants commented that content needed to be specific, and videos needed to be shorter, to be tailored to severity of condition, to demonstrate “normal” activities, to be positive, and to ensure that content is culturally relevant. Conclusions. This study demonstrated that detailed analysis of patient perspectives and needs for self-management is essential and should underpin the development of any framework, materials, and technology. The action research design principles provided an effective framework for eliciting the data and applying it to technology and testing its relevance to the user. Catherine McCabe, John Dinsmore, Anne Marie Brady, Gabrielle Mckee, Sharon O'Donnell, and David Prendergast Copyright © 2014 Catherine McCabe et al. All rights reserved. A Wireless Emergency Telemedicine System for Patients Monitoring and Diagnosis Tue, 06 May 2014 00:00:00 +0000 Recently, remote healthcare systems have received increasing attention in the last decade, explaining why intelligent systems with physiology signal monitoring for e-health care are an emerging area of development. Therefore, this study adopts a system which includes continuous collection and evaluation of multiple vital signs, long-term healthcare, and a cellular connection to a medical center in emergency case and it transfers all acquired raw data by the internet in normal case. The proposed system can continuously acquire four different physiological signs, for example, ECG, SpO2, temperature, and blood pressure and further relayed them to an intelligent data analysis scheme to diagnose abnormal pulses for exploring potential chronic diseases. The proposed system also has a friendly web-based interface for medical staff to observe immediate pulse signals for remote treatment. Once abnormal event happened or the request to real-time display vital signs is confirmed, all physiological signs will be immediately transmitted to remote medical server through both cellular networks and internet. Also data can be transmitted to a family member’s mobile phone or doctor’s phone through GPRS. A prototype of such system has been successfully developed and implemented, which will offer high standard of healthcare with a major reduction in cost for our society. M. Abo-Zahhad, Sabah M. Ahmed, and O. Elnahas Copyright © 2014 M. Abo-Zahhad et al. All rights reserved.