http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2013 , Hindawi Publishing Corporation . All rights reserved. Sat, 27 Apr 2013 10:29:19 +0000 http://www.hindawi.com/journals/ijta/2013/305819/ The purpose of this study was to validate a previously developed heart failure readmission predictive algorithm based on psychosocial factors, develop a new model based on patient-reported symptoms from a telemonitoring program, and assess the impact of weight fluctuations and other factors on hospital readmission. Clinical, demographic, and telemonitoring data was collected from 100 patients enrolled in the Partners Connected Cardiac Care Program between July 2008 and November 2011. 38% of study participants were readmitted to the hospital within 30 days. Ten different heart-failure-related symptoms were reported 17,389 times, with the top three contributing approximately 50% of the volume. The psychosocial readmission model yielded an AUC of 0.67, along with sensitivity 0.87, specificity 0.32, positive predictive value 0.44, and negative predictive value 0.8 at a cutoff value of 0.30. In summary, hospital readmission models based on psychosocial characteristics, standardized changes in weight, or patient-reported symptoms can be developed and validated in heart failure patients participating in an institutional telemonitoring program. However, more robust models will need to be developed that use a comprehensive set of factors in order to have a significant impact on population health. Adrian H. Zai, Jeremiah G. Ronquillo, Regina Nieves, Henry C. Chueh, Joseph C. Kvedar, and Kamal Jethwani Copyright © 2013 Adrian H. Zai et al. All rights reserved. Mon, 22 Apr 2013 15:20:58 +0000 http://www.hindawi.com/journals/ijta/2013/696813/ Despite recent advances in the area of home telemonitoring, the challenge of automatically detecting the sound signatures of activities of daily living of an elderly patient using nonintrusive and reliable methods remains. This paper investigates the classification of eight typical sounds of daily life from arbitrarily positioned two-microphone sensors under realistic noisy conditions. In particular, the role of several source separation and sound activity detection methods is considered. Evaluations on a new four-microphone database collected under four realistic noise conditions reveal that effective sound activity detection can produce significant gains in classification accuracy and that further gains can be made using source separation methods based on independent component analysis. Encouragingly, the results show that recognition accuracies in the range 70%–100% can be consistently obtained using different microphone-pair positions, under all but the most severe noise conditions. David Maunder, Julien Epps, Eliathamby Ambikairajah, and Branko Celler Copyright © 2013 David Maunder et al. All rights reserved. Mon, 15 Apr 2013 11:49:15 +0000 http://www.hindawi.com/journals/ijta/2013/834514/ Zia Agha, Charlene R. Weir, and Yunan Chen Copyright © 2013 Zia Agha et al. All rights reserved. Wed, 10 Apr 2013 10:49:26 +0000 http://www.hindawi.com/journals/ijta/2013/461829/ Introduction. Information and communication technology (ICT) are becoming a natural part in healthcare both for delivering and giving accessibility to healthcare for people with chronic illness living at home. Aim. The aim was to review existing studies describing the use of ICT in home care for communication between patients, family members, and healthcare professionals. Methods. A review of studies was conducted that identified 1,276 studies. A selection process and quality appraisal were conducted, which finally resulted in 107 studies. Results. The general results offer an overview of characteristics of studies describing the use of ICT applications in home care and are summarized in areas including study approach, quality appraisal, publications data, terminology used for defining the technology, and disease diagnosis. The specific results describe how communication with ICT was performed in home care and the benefits and drawbacks with the use of ICT. Results were predominated by positive responses in the use of ICT. Conclusion. The use of ICT applications in home care is an expanding research area, with a variety of ICT tools used that could increase accessibility to home care. Using ICT can lead to people living with chronic illnesses gaining control of their illness that promotes self-care. Birgitta Lindberg, Carina Nilsson, Daniel Zotterman, Siv Söderberg, and Lisa Skär Copyright © 2013 Birgitta Lindberg et al. All rights reserved. Thu, 14 Mar 2013 15:47:34 +0000 http://www.hindawi.com/journals/ijta/2013/239382/ Incomplete patient adherence with nasal continuous positive airway pressure (CPAP) limits the effectiveness of treatment and results in suboptimal obstructive sleep apnea (OSA) outcomes. An interactive website specifically designed for patients with OSA was designed and utilized in a randomized clinical trial to test its effect on increasing CPAP adherence. The goal of this paper is to report on CPAP adherence, internet use, privacy concerns and user satisfaction in using the website. The original project was designed as a randomized, controlled clinical trial of Usual Care (UC, control) versus MyCPAP group (intervention). Questionnaires were administered to evaluate the patient perspective of using the MyCPAP website. Participation in the MyCPAP intervention resulted in higher CPAP adherence at the two-month time point relative to participation in the UC group (3.4  ±  2.4 and 4.1  ±  2.3 hrs/nt; ; mean  ±  SD). Participants randomized to the MyCPAP website increased their use of the internet to obtain OSA related information, but did not increase their use of the internet to get information on general health or medical conditions. Users had very little concern about their CPAP data being viewed daily or being sent over the internet. Future studies should consider the use of newer evaluation criteria for collaborative adaptive interactive technologies. Carl Stepnowsky, Christine Edwards, Tania Zamora, Robert Barker, and Zia Agha Copyright © 2013 Carl Stepnowsky et al. All rights reserved. Wed, 13 Mar 2013 09:04:21 +0000 http://www.hindawi.com/journals/ijta/2013/457491/ An m-health system for real-time wireless communication of medical video based on open-source software is presented. The objective is to deliver a low-cost telemedicine platform which will allow for reliable remote diagnosis m-health applications such as emergency incidents, mass population screening, and medical education purposes. The performance of the proposed system is demonstrated using five atherosclerotic plaque ultrasound videos. The videos are encoded at the clinically acquired resolution, in addition to lower, QCIF, and CIF resolutions, at different bitrates, and four different encoding structures. Commercially available wireless local area network (WLAN) and 3.5G high-speed packet access (HSPA) wireless channels are used to validate the developed platform. Objective video quality assessment is based on PSNR ratings, following calibration using the variable frame delay (VFD) algorithm that removes temporal mismatch between original and received videos. Clinical evaluation is based on atherosclerotic plaque ultrasound video assessment protocol. Experimental results show that adequate diagnostic quality wireless medical video communications are realized using the designed telemedicine platform. HSPA cellular networks provide for ultrasound video transmission at the acquired resolution, while VFD algorithm utilization bridges objective and subjective ratings. A. Panayides, I. Eleftheriou, and M. Pantziaris Copyright © 2013 A. Panayides et al. All rights reserved. Tue, 05 Mar 2013 13:40:05 +0000 http://www.hindawi.com/journals/ijta/2013/650238/ Objective. This study chose patients with chronic diseases as study subjects to investigate their intention to use telecare. Methods. A large medical institute in Taiwan was used as the sample unit. Patients older than 20 years, who had chronic diseases, were sampled by convenience sampling and surveyed with a structural questionnaire, and a total of 500 valid questionnaires were collected. Model construction was based on the Health Belief Model. The reliability and validity of the measurement model were tested using confirmatory factor analysis (CFA), and the causal model was explained by structural equation modeling (SEM). Results. The priority should be on promoting the perceived benefits of telecare, with a secondary focus on the external cues to action, such as promoting the influences of important people on the patients. Conclusion. The findings demonstrated that patients with chronic diseases use telecare differently from the general public. To promote the use and acceptance of telecare in patients with chronic diseases, technology developers should prioritize the promotion of the usefulness of telecare. In addition, policy makers can strengthen the marketing from media and medical personnel, in order to increase the acceptance of telecare by patients with chronic diseases. Jui-Chen Huang and Yii-Ching Lee Copyright © 2013 Jui-Chen Huang and Yii-Ching Lee. All rights reserved. Wed, 19 Dec 2012 18:36:06 +0000 http://www.hindawi.com/journals/ijta/2012/806464/ Purpose. To describe integration of fundus autofluorescence (FAF) imaging into an ocular screening program. Methods. Fifty consecutive screening participants were included in this prospective pilot imaging study. Color and FAF (530/640 nm exciter/barrier filters) images were obtained with a 15.1MP Canon nonmydriatic hybrid camera. A clinician evaluated the images on site to determine need for referral. Visual acuity (VA), intraocular pressure (IOP), and ocular pathology detected by color fundus and FAF imaging modalities were recorded. Results. Mean ± SD age was 47.4 ± 17.3 years. Fifty-two percent were female and 58% African American. Twenty-seven percent had a comprehensive ocular examination within the past year. Mean VA was 20/39 in the right eye and 20/40 in the left eye. Mean IOP was 15 mmHg bilaterally. Positive color and/or FAF findings were identified in nine (18%) individuals with diabetic retinopathy or macular edema (), focal RPE defects (), age-related macular degeneration (), central serous retinopathy (), and ocular trauma (). Conclusions. FAF was successfully integrated in our ocular screening program and aided in the identification of ocular pathology. Larger studies examining the utility of this technology in screening programs may be warranted. A. M. Kolomeyer, N. V. Nayak, B. C. Szirth, and A. S. Khouri Copyright © 2012 A. M. Kolomeyer et al. All rights reserved. Mon, 17 Dec 2012 14:00:10 +0000 http://www.hindawi.com/journals/ijta/2012/894869/ We introduce PERCEPT system, an indoor navigation system for the blind and visually impaired. PERCEPT will improve the quality of life and health of the visually impaired community by enabling independent living. Using PERCEPT, blind users will have independent access to public health facilities such as clinics, hospitals, and wellness centers. Access to healthcare facilities is crucial for this population due to the multiple health conditions that they face such as diabetes and its complications. PERCEPT system trials with 24 blind and visually impaired users in a multistory building show PERCEPT system effectiveness in providing appropriate navigation instructions to these users. The uniqueness of our system is that it is affordable and that its design follows orientation and mobility principles. We hope that PERCEPT will become a standard deployed in all indoor public spaces, especially in healthcare and wellness facilities. Aura Ganz, James Schafer, Siddhesh Gandhi, Elaine Puleo, Carole Wilson, and Meg Robertson Copyright © 2012 Aura Ganz et al. All rights reserved. Thu, 13 Dec 2012 08:59:48 +0000 http://www.hindawi.com/journals/ijta/2012/973237/ Millennium Development Goals (MDGs) are unlikely to be met in most low- and middle-income countries (LMIC). Smartphones and smartphone proxy systems using simpler phones, equipped with the capabilities to identify location/time and link to the web, are increasingly available and likely to provide an excellent platform to support healthcare self-management, delivery, quality, and supervision. Smart phones allow information to be delivered by voice, texts, pictures, and videos as well as be triggered by location and date. Prompts and reminders, as well as real-time monitoring, can improve quality of health care. We propose a three-tier model for designing platforms for both professional and paraprofessional health providers and families: (1) foundational functions (informing, training, monitoring, shaping, supporting, and linking to care); (2) content-specific targets (e.g., for MDG; developmentally related tasks); (3) local cultural adaptations (e.g., language). We utilize the Maternal and Child Health (MCH) MDG in order to demonstrate how the existing literature can be organized and leveraged on open-source platforms and provide examples using our own experience in Africa over the last 8 years. Mary Jane Rotheram-Borus, Mark Tomlinson, Dallas Swendeman, Adabel Lee, and Erynne Jones Copyright © 2012 Mary Jane Rotheram-Borus et al. All rights reserved. Sun, 09 Dec 2012 09:41:27 +0000 http://www.hindawi.com/journals/ijta/2012/162673/ This work describes the usability studies conducted in the development of an experience-sampling methodology (ESM) system running in a mobile device. The goal of the system is to improve the accuracy and ecology in gathering daily self-report data in individuals suffering a chronic pain condition, fibromyalgia. The usability studies showed that the developed software to conduct ESM with mobile devices (smartphones, cell phones) can be successfully used by individuals with fibromyalgia of different ages and with low level of expertise in the use of information and communication technologies. 100% of users completed the tasks successfully, although some have completely illiterate. Also there seems to be a clear difference in the way of interaction obtained in the two studies carried out. Castilla Diana, Botella Cristina, García-Palacios Azucena, Farfallini Luis, and Miralles Ignacio Copyright © 2012 Castilla Diana et al. All rights reserved. Thu, 06 Dec 2012 16:22:18 +0000 http://www.hindawi.com/journals/ijta/2012/673731/ The paper addresses an ICT-based, user-driven innovation process in the health sector in rural areas in Norway. The empirical base is the introduction of a new model for psychiatric health provision. This model is supported by a technical solution based on mobile phones that is aimed to help the communication between professional health personnel and patients. This innovation was made possible through the use of standard mobile technology rather than more sophisticated systems. The users were heavily involved in the development work. Our analysis shows that by thinking simple and small-scale solutions, including to take the user’s needs and premises as a point of departure rather than focusing on advanced technology, the implementation process was made possible. We show that by combining theory on information infrastructures, user-oriented system development, and innovation in a three-layered analytical framework, we can explain the interrelationship between technical, organizational, and health professional factors that made this innovation a success. Synnøve Thomassen Andersen and Arild Jansen Copyright © 2012 Synnøve Thomassen Andersen and Arild Jansen. All rights reserved. Thu, 06 Dec 2012 12:13:54 +0000 http://www.hindawi.com/journals/ijta/2012/104561/ Moving from the experience gained in home telemonitoring of elderly patients with Congestive Heart Failure, that confirmed a reduction of the rehospitalization rate and an improved monitoring of drugs assumption by the patients, this paper extends the evaluation of technological approaches for remote health monitoring of older adults. Focus of the evaluation is on telemedicine effectiveness and usability, either from a patient’s or a medical operator’s perspective. The evaluation has been performed by testing three remote health platforms designed according to different technological approaches, in a realistic scenario involving older adults and medical operators (doctors and nurses). The aim of the testing activity was not to benchmark a specific solution with respect to the others, but to evaluate the main positive and negative issues related to the system and service design philosophy each solution was built upon. Though preliminary, the results discussed in the paper can be used as a set of guidelines in the selection of proper technological equipments for services targeted to elderly users, from a usability perspective. These results need to be complemented with more focused discussions of the ethical, medical, and legal aspects of the use of technology in remote healthcare. Susanna Spinsante, Roberto Antonicelli, Ilaria Mazzanti, and Ennio Gambi Copyright © 2012 Susanna Spinsante et al. All rights reserved. Wed, 05 Dec 2012 17:00:18 +0000 http://www.hindawi.com/journals/ijta/2012/871925/ Background. Self-management support and team-based care are essential elements of the Chronic Care Model but are often limited by staff availability and reimbursement. Mobile phones are a promising platform for improving chronic care but there are few examples of successful health system implementation. Program Development. An iterative process of program design was built upon a pilot study and engaged multiple institutional stakeholders. Patients identified having a “human face” to the pilot program as essential. Stakeholders recognized the need to integrate the program with primary and specialty care but voiced concerns about competing demands on clinician time. Program Description. Nurse administrators at a university-affiliated health plan use automated text messaging to provide personalized self-management support for member patients with diabetes and facilitate care coordination with the primary care team. For example, when a patient texts a request to meet with a dietitian, a nurse-administrator coordinates with the primary care team to provide a referral. Conclusion. Our innovative program enables the existing health system to support a de novo care management program by leveraging mobile technology. The program supports self-management and team-based care in a way that we believe engages patients yet meets the limited availability of providers and needs of health plan administrators. Shantanu Nundy, Jonathan J. Dick, Anna P. Goddu, Patrick Hogan, Chen-Yuan E. Lu, Marla C. Solomon, Arnell Bussie, Marshall H. Chin, and Monica E. Peek Copyright © 2012 Shantanu Nundy et al. All rights reserved. Wed, 05 Dec 2012 13:35:45 +0000 http://www.hindawi.com/journals/ijta/2012/297416/ The aim of this study was to summarize and analyse findings from four prior studies on the use of the Internet as a source of health information in five European countries (Norway, Denmark, Germany, Greece, and Portugal). A cross-study comparison of data was performed. All the studies included fit with a trend of a sharp and continuous growth in the use of the Internet for health information access in the major part of the last decade. Importantly, the Internet has become an important mass media source of health information in northern Europe. While the use of the Internet for health information is somewhat less common in the south European countries, its use is also clearly increasing there. We discuss the advantages of cross-study comparisons of data and methodological challenges. As the use of the Internet for health information is likely to peak in some countries in the near future, new population surveys on health information access should focus more on the details of information that is accessed and which sites that are most used and trusted. Per Egil Kummervold and Rolf Wynn Copyright © 2012 Per Egil Kummervold and Rolf Wynn. All rights reserved. Mon, 03 Dec 2012 11:44:36 +0000 http://www.hindawi.com/journals/ijta/2012/269637/ Experience shows that there are great defects in information and collaboration between families and professionals in the health and care sector. In an attempt to improve the quality of the efforts planned and implemented in collaboration with relatives a family-related IT-based collaboration system called CIDC was constructed. With the intention to facilitate communication, information, documentation, and collaboration the system was tested together with parents of children with cognitive impairment. The system contains a number of functions gathered in a so-called e-collaboration room. The person administering and distributing the system authorizes the patient/care recipient or relative to build up an e-collaboration room. The result has been largely positive, but the part, which was supposed to document everyday activities, leaves much to be desired. For this reason a follow-up study was completed, and an iPad was used as a contact book, which with the help of the Dropbox software provided increased insight into the child and improved the contact with parents without losing confidentiality or causing extra workload for the staff. By automatic download from the iPad parents and/or contact persons could easily follow the documentation of children’s everyday activities. Peter Karlsudd Copyright © 2012 Peter Karlsudd. All rights reserved. Sun, 25 Nov 2012 08:30:08 +0000 http://www.hindawi.com/journals/ijta/2012/438736/ Objectives. This study investigated the activity behavior of patients with COPD in detail compared to asymptomatic controls, and the relationship between subjective and objective activities (awareness), and readiness to change activity behavior. Methods. Thirty-nine patients with COPD (66.0 years; FEV1% predicted: 44.9%) and 21 healthy controls (57.0 years) participated. Objective daily activity was assessed by accelerometry and expressed as amount of activity in counts per minute (cpm). Patients' baseline subjective activity and stage of change were assessed prior to measurements. Results. Mean daily activity in COPD patients was significantly lower compared to the healthy controls ( cpm versus  cpm, ). COPD patients showed a temporary decrease in objective activities in the early afternoon. Objective and subjective activities were significantly moderately related and most patients (55.3%) were in the maintenance phase of the stages of change. Conclusions. COPD patients show a distinctive activity decrease in the early afternoon. COPD patients are moderately aware of their daily activity but regard themselves as physically active. Therefore, future telemedicine interventions might consider creating awareness of an active lifestyle and provide feedback that aims to increase and balance activity levels. Monique Tabak, Miriam M. R. Vollenbroek-Hutten, Paul D. L. P. M. van der Valk, Job van der Palen, Thijs M. Tönis, and Hermie J. Hermens Copyright © 2012 Monique Tabak et al. All rights reserved. Sun, 18 Nov 2012 09:33:49 +0000 http://www.hindawi.com/journals/ijta/2012/195970/ A telemedicine system is described for monitoring vital signs and general health indicators of patients with cardiac and diabetic conditions. Telemetry from wireless sensors and readings from other instruments are combined into a comprehensive set of measured patient parameters. Using a combination of mobile device applications and web browser, the data can be stored, accessed, and displayed using mobile internet communications to the central server. As an extra layer of security in the data transmission, information embedded in the data is used in its verification. The paper highlights features that could be enhanced from previous systems by using alternative components or methods. David Mulvaney, Bryan Woodward, Sekharjit Datta, Paul Harvey, Anoop Vyas, Bhaskar Thakker, Omar Farooq, and Robert Istepanian Copyright © 2012 David Mulvaney et al. All rights reserved. Mon, 05 Nov 2012 07:52:32 +0000 http://www.hindawi.com/journals/ijta/2012/945745/ Shoulder disorders are common, debilitating, and represent a considerable burden on society. As primary contact practitioners, physiotherapists play a large role in the management and rehabilitation of people with these conditions. For those living outside of urban areas, however, access to physiotherapy can be limited. The aim of this study was to evaluate the validity and reliability of using a telerehabilitation system to collect physical examination findings and correctly identify disorders of the shoulder. Twenty-two participants with 28 shoulder disorders were recruited and underwent a face-to-face physical examination and a remote telerehabilitation examination. Examination findings and diagnoses from the two modes of assessment were used to determine validity and reliability of the new method. Diagnostic agreement and agreement on individual findings between the two methods were found to be consistent with the reliability of conventional assessment methods. This study provides important preliminary findings on the validity and reliability of musculoskeletal examinations conducted via telerehabilitation. Leah Steele, Hannah Lade, Stephanie McKenzie, and Trevor G. Russell Copyright © 2012 Leah Steele et al. All rights reserved. Tue, 25 Sep 2012 18:25:08 +0000 http://www.hindawi.com/journals/ijta/2012/460712/ Purpose. The SenseWear Armband (SWA) is a multisensor activity monitor that can be used in daily life to assess an individual’s physical activity level (PAL). The primary goal of this study was to analyze the impact of different types of feedback on the PAL of Flemish employees. Methods/Design. We recruited 320 sedentary employees (age, 41.0 ± 10.7 years; BMI, 26.2 ± 4.2 kg/m2) to participate in the 12-month study. Participants were randomized into one of four intervention groups after being measured for 7 days and nights by means of the SWA: (1) a minimal intervention group received no feedback (MIG, ); (2) a pedometer group was provided only information on their daily step count (PG, ); (3) a display group received feedback on calories burned, steps taken, and minutes of physical activity by means of the SWA display (DG, ); (4) a coaching group also received the display and had weekly meetings with a Personal Coach (CoachG, ). We hypothesize that participants receiving feedback (SG, DG, and CoachG) will have a greater increase in physical activity outcome variables compared to participants of the minimal intervention group. Karen Van Hoye, Filip Boen, and Johan Lefevre Copyright © 2012 Karen Van Hoye et al. All rights reserved. Mon, 24 Sep 2012 09:59:13 +0000 http://www.hindawi.com/journals/ijta/2012/798791/ Pulmonary rehabilitation is an effective treatment for people with chronic obstructive pulmonary disease. However, access to these services is limited especially in rural and remote areas. Telerehabilitation has the potential to deliver pulmonary rehabilitation programs to these communities. The aim of this study was threefold: to establish the technical feasibility of transmitting real-time pulse oximetry data, determine the validity of remote measurements compared to conventional face-to-face measures, and evaluate the participants’ perception of the usability of the technology. Thirty-seven healthy individuals participated in a single remote pulmonary rehabilitation exercise session, conducted using the eHAB telerehabilitation system. Validity was assessed by comparing the participant's oxygen saturation and heart rate with the data set received at the therapist’s remote location. There was an 80% exact agreement between participant and therapist data sets. The mean absolute difference and Bland and Altman’s limits of agreement fell within the minimum clinically important difference for both oxygen saturation and heart rate values. Participants found the system easy to use and felt confident that they would be able to use it at home. Remote measurement of pulse oximetry data for a pulmonary rehabilitation exercise session was feasible and valid when compared to conventional face-to-face methods. Jonathan Tang, Allison Mandrusiak, and Trevor Russell Copyright © 2012 Jonathan Tang et al. All rights reserved. Thu, 13 Sep 2012 11:19:33 +0000 http://www.hindawi.com/journals/ijta/2012/132719/ Undoubtedly, the identification of patient suitability for a telerehabilitation assessment should be carried out on a case-by-case basis. However, at present there is minimal discussion of how telerehabilitation systems can accommodate and adapt to various patient factors, which may pose challenges to successful service delivery. The current study examines a subgroup of 10 patients who underwent an online assessment of their swallowing difficulties. Although all assessments were completed successfully; there were certain patient factors, which complicated the delivery of the online assessment session. The paper presents a discussion of the main patient factors observed in this cohort including the presence of speech and/or voice disorders, hearing impairment, dyskinesia, and behavioural and/or emotional issues and examines how the assessment session, the telerehabilitation system, and the staff involved were manipulated to accommodate these patient factors. In order for telerehabilitation systems to be more widely incorporated into routine clinical care, systems need to have the flexibility and design capabilities to adjust and accommodate for patients with varying levels of function and physical and psychological comorbidities. Elizabeth C. Ward, Shobha Sharma, Clare Burns, Deborah Theodoros, and Trevor Russell Copyright © 2012 Elizabeth C. Ward et al. All rights reserved. Mon, 10 Sep 2012 08:38:02 +0000 http://www.hindawi.com/journals/ijta/2012/715194/ Introduction. Telemedicine is promoted as a means to increase access to specialty medical care among the urban underserved, yet little is known about its acceptability among these populations. We used components of a diffusion of innovation conceptual framework to analyze preexperience perceptions about telemedicine to assess its appeal among urban underserved African Americans and Latinos. Methods. Ten focus groups were conducted with African American (𝑛=43) and Latino participants (𝑛=44) in both English and Spanish and analyzed for key themes. Results. Both groups perceived increased and immediate access to multiple medical opinions and reduced wait time as relative advantages of telemedicine. However, African Americans expressed more concerns than Latinos about confidentiality, privacy, and the physical absence of the specialist. This difference may reflect lower levels of trust in new health care innovations among African Americans resulting from a legacy of past abuses in the US medical system as compared to immigrant Latinos who do not have this particular historical backdrop. Conclusions. These findings have implications for important issues such as adoption of telemedicine, patient satisfaction, doctor-patient interactions, and the development and tailoring of strategies targeted to each of these populations for the introduction, marketing, and implementation of telemedicine. Sheba George, Alison Hamilton, and Richard S. Baker Copyright © 2012 Sheba George et al. All rights reserved. Thu, 30 Aug 2012 15:08:52 +0000 http://www.hindawi.com/journals/ijta/2012/103685/ The Patient-Centered Medical Home (PCMH) is a primary care model that provides coordinated and comprehensive care to patients to improve health outcomes. This paper addresses practical issues that arise when transitioning a traditional primary care practice into a PCMH recognized by the National Committee for Quality Assurance (NCQA). Individual organizations' experiences with this transition were gathered at a PCMH workshop in Alexandria, Virginia in June 2010. An analysis of their experiences has been used along with a literature review to reveal common challenges that must be addressed in ways that are responsive to the practice and patients’ needs. These are: NCQA guidance, promoting provider buy-in, leveraging electronic medical records, changing office culture, and realigning workspace in the practice to accommodate services needed to carry out the intent of PCMH. The NCQA provides a set of standards for implementing the PCMH model, but these standards lack many specifics that will be relied on in location situations. While many researchers and providers have made critiques, we see this vagueness as allowing for greater flexibility in how a practice implements PCMH. Ellen P. Green, John Wendland, M. Colette Carver, Cortney Hughes Rinker, and Seong K. Mun Copyright © 2012 Ellen P. Green et al. All rights reserved. Tue, 28 Aug 2012 08:54:59 +0000 http://www.hindawi.com/journals/ijta/2012/729492/ Home telehealth can improve clinical outcomes for conditions that are common among patients with spinal cord injury (SCI). However, little is known about the costs and potential savings associated with its use. We developed clinical scenarios that describe common situations in treatment or prevention of pressure ulcers. We calculated the cost implications of using telehealth for each scenario and under a range of reasonable assumptions. Data were gathered primarily from US Department of Veterans Affairs (VA) administrative records. For each scenario and treatment method, we multiplied probabilities, frequencies, and costs to determine the expected cost over the entire treatment period. We generated low-, medium-, and high-cost estimates based on reasonable ranges of costs and probabilities. Telehealth care was less expensive than standard care when low-cost technology was used but often more expensive when high-cost, interactive devices were installed in the patient’s home. Increased utilization of telehealth technology (particularly among rural veterans with SCI) could reduce the incidence of stage III and stage IV ulcers, thereby improving veterans' health and quality of care without increasing costs. Future prospective studies of our present scenarios using patients with various healthcare challenges are recommended. Mark W. Smith, Michelle L. Hill, Karen L. Hopkins, B. Jenny Kiratli, and Ruth C. Cronkite Copyright © 2012 Mark W. Smith et al. All rights reserved. Thu, 16 Aug 2012 11:35:26 +0000 http://www.hindawi.com/journals/ijta/2012/736264/ Development of new personal mobile and wireless devices for healthcare has become essential due to our aging population characterized by constant rise in chronic diseases that consequently require a complex treatment and close monitoring. Personal telehealth devices allow patients to adequately receive their appropriate treatment, followup with their doctors, and report any emergency without the need of the presence of any caregivers with them thus increasing their quality of life in a cost-effective fashion. This paper includes a brief overview of personal telehealth systems, a survey of 100 consecutive ED patients aged >65 years, and introduces “Limmex” a new GSM based technology packaged in a wristwatch. Limmex can by a push of a button initiate multiple emergency call and establish mobile communication between the patient and a preselected person, institution, or a search and rescue service. To the best of our knowledge, Limmex is the first of its kind worldwide. Malek Tabbara, Thomas Hodel, Urs Müller, Gabi Briner, Heinz Zimmermann, and Aristomenis K. Exadaktylos Copyright © 2012 Malek Tabbara et al. All rights reserved. Wed, 15 Aug 2012 13:00:32 +0000 http://www.hindawi.com/journals/ijta/2012/861860/ Persons with disability from spinal cord injury (SCI) are subject to high risk of pathological events and need a regular followup even after discharge from the rehabilitation hospital. To help in followup, we developed a web portal for providing online specialist as well as GP support to SCI persons. After a feasibility study with 13 subjects, the portal has been introduced in the regional healthcare network in order to make it compliant with current legal regulations on data protection, including smartcard authentication. Although a number of training courses have been made to introduce SCI persons to portal use (up to 50 users), the number of accesses remained very low. Reasons for that have been investigated by means of a questionnaire submitted to the initial feasibility study subjects and included the still easier use of telephone versus our web-based smartcard-authenticated portal, in particular, because online communications are still perceived as an unusual way of interacting with the doctor. To summarize, the overall project has been appreciated by the users, but when it is time to ask for help to, the specialist, it is still much easier to make a phone call. Vincenzo Della Mea, Dario Marin, Claudio Rosin, and Agostino Zampa Copyright © 2012 Vincenzo Della Mea et al. All rights reserved. Mon, 07 May 2012 08:37:16 +0000 http://www.hindawi.com/journals/ijta/2012/713739/ Telehealth is the exchange of health information and the provision of health care services through electronic information and communications technology, where participants are separated by geographic, time, social and cultural barriers. The shift of telemedicine from desktop platforms to wireless and mobile technologies is likely to have a significant impact on healthcare in the future. It is therefore crucial to develop a general information exchange e-medical system to enables its users to perform online and offline medical consultations through diagnosis. During the medical diagnosis, image analysis techniques combined with doctor’s opinions could be useful for final medical decisions. Quantitative analysis of digital images requires detection and segmentation of the borders of the object of interest. In medical images, segmentation has traditionally been done by human experts. Even with the aid of image processing software (computer-assisted segmentation tools), manual segmentation of 2D and 3D CT images is tedious, time-consuming, and thus impractical, especially in cases where a large number of objects must be specified. Substantial computational and storage requirements become especially acute when object orientation and scale have to be considered. Therefore automated or semi-automated segmentation techniques are essential if these software applications are ever to gain widespread clinical use. The main purpose of this work is to analyze segmentation techniques for the definition of anatomical structures under telemedical systems. S. Zimeras and L. G. Gortzis Copyright © 2012 S. Zimeras and L. G. Gortzis. All rights reserved. Thu, 22 Mar 2012 08:38:30 +0000 http://www.hindawi.com/journals/ijta/2012/843527/ In wireless healthcare monitoring systems, bandwidth allocation is an efficient solution to the problem of scarce wireless bandwidth for the monitoring of patients. However, when the central unit cannot access the exact channel state information (CSI), the efficiency of bandwidth allocation decreases, and the system performance also decreases. In this paper, we propose an algorithm to reduce the negative effects of imperfect CSI on system performance. In this algorithm, the central unit can predict the current CSI by previous CSI when the current CSI is not available. We analyze the reliability of the proposed algorithm by deducing the standard error of estimated CSI with this algorithm. In addition, we analyze the efficiency of the proposed algorithm by discussing the system performance with this algorithm. Di Lin and Fabrice Labeau Copyright © 2012 Di Lin and Fabrice Labeau. All rights reserved. Sun, 18 Mar 2012 13:50:53 +0000 http://www.hindawi.com/journals/ijta/2012/437350/ Blood pressure self-measurement (BPSM) requires patients to follow a range of recommendations in order to be considered reliable for diagnostic use. We investigated currently used BPSM interventions at four medical clinics combined with an online questionnaire targeting BPSM users. We found that the participating healthcare personnel perceived BPSM as a relevant and useful intervention method providing that the recommendations are followed. A total of six challenges were identified: (1) existing devices do not guarantee that the recommendations are followed, (2) healthcare providers cannot verify whether self-monitoring patients follow the recommendations, (3) patients are not aware of all recommendations and the need to follow them, (4) risk of patient induced reporting bias, (5) risk of healthcare provider induced data-transfer bias, and (6) risk of data being registered as belonging to the wrong patient. We conclude that existing BPSM interventions could be significantly affected by user-induced bias resulting in an indeterminable quality of the measurement data. Therefore, we suggest applying context-aware technological support tools to better detect and quantify user errors. This may allow us to develop solutions that could overcome or compensate for such errors in the future. Stefan Wagner, Thomas Skjødeberg Toftegaard, and Olav W. Bertelsen Copyright © 2012 Stefan Wagner et al. All rights reserved.