International Journal of Telemedicine and Applications The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . 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 () 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. Web-Based Depression Screening and Psychiatric Consultation for College Students: A Feasibility and Acceptability Study Sun, 30 Mar 2014 07:29:47 +0000 Background. A steady rise in the prevalence of depression among college students has negatively affected student quality of life. This study investigates the feasibility and acceptability of a Web-based model, including Skype, to screen and provide psychiatric consultation to depressed college students. Methods. Students completed the 9-item Patient Health Questionnaire (PHQ-9) online; those who screened positive (PHQ-9 ≥ 10) or endorsed any level of suicidal ideation were offered Web-based psychiatric consultation using Skype. After the consultation, students filled out a 7-item satisfaction questionnaire to report on the acceptability of this Web-based method. Results. A total of 972 students consented to the online depression screening and 285 screened positive. Of those, 69 students consented and 17 students successfully completed the psychiatric consultation via Skype. Thirteen (76.4%) students found the interview useful in helping them understand their depression. Fifteen (88.2%) students thought that psychologists and psychiatrists could successfully see patients via videoconferencing. Conclusions. Current online technologies can provide depression screening and psychiatric consultation to college students; those who participated reported a positive experience. Future studies will need to address the low levels of participation among college students and attract students who are underserved, as well as use a videoconferencing platform that adequately protects data confidentiality. Aya Williams, Rachel LaRocca, Trina Chang, Nhi-Ha Trinh, Maurizio Fava, Joseph Kvedar, and Albert Yeung Copyright © 2014 Aya Williams et al. All rights reserved. Is Telephysiotherapy an Option for Improved Quality of Life in Patients with Osteoarthritis of the Knee? Sun, 23 Mar 2014 13:59:52 +0000 This study investigated effect of a 6-week telephysiotherapy programme on quality of life (QoL) of patients with knee osteoarthritis (OA). Fifty patients with knee OA were randomly and equally assigned into two treatment groups: clinic group (CG) and telephysiotherapy group (TG). The CG received physiotherapist-administered osteoarthritis-specific exercises in the clinic thrice weekly for 6 weeks while the TG received structured telephone monitoring with self-administered osteoarthritis-specific exercises for the same duration at home. Participants’ QoL was assessed using WHOQoL-Bref at baseline, second, fourth, and sixth week of intervention. Data were analyzed using ANOVA and independent Student’s -test. Within-group comparison showed significant improvements in physical health domain ( for TG and CG) and psychological domain ( for TG; for CG) of WHOQoL following six-week intervention. However, there were no significant differences () in TG and CG’s social relationship and environment domains. Between-group comparison showed no significant differences () between CG and TG’s physical health, psychological, and social relationships domains of WHOQoL following 6-week intervention. However, there was significant difference in the environment domain (). Telephysiotherapy using telephone medium improved QoL in patients with knee OA comparable to clinic based treatment. Adesola C. Odole and Oluwatobi D. Ojo Copyright © 2014 Adesola C. Odole and Oluwatobi D. Ojo. All rights reserved. Effect of Wireless Channels on Detection and Classification of Asthma Attacks in Wireless Remote Health Monitoring Systems Mon, 10 Feb 2014 13:45:53 +0000 This paper aims to study the performance of support vector machine (SVM) classification in detecting asthma attacks in a wireless remote monitoring scenario. The effect of wireless channels on decision making of the SVM classifier is studied in order to determine the channel conditions under which transmission is not recommended from a clinical point of view. The simulation results show that the performance of the SVM classification algorithm in detecting asthma attacks is highly influenced by the mobility of the user where Doppler effects are manifested. The results also show that SVM classifiers outperform other methods used for classification of cough signals such as the hidden markov model (HMM) based classifier specially when wireless channel impairments are considered. Orobah Al-Momani and Khaled M. Gharaibeh Copyright © 2014 Orobah Al-Momani and Khaled M. Gharaibeh. All rights reserved. Adapting a Database of Text Messages to a Mobile-Based Weight Loss Program: The Case of the Middle East Mon, 06 Jan 2014 12:18:57 +0000 Obesity has become a worldwide epidemic. Qatar, a rapidly developing country in the Middle East, has seen a sharp increase in the prevalence of obesity. The increase can be attributed to several reasons, including sedentary lifestyles imposed by a harsh climate and the introduction of Western fast food. Mobile technologies have been used and studied as a technology to support individuals’ weight loss. The authors have developed a mobile application that implements three strategies drawn from proven theories of behavioral change. The application is localized to the cultural context of its proposed users. The objective of this paper is to present a method through which we adapted the messaging content of a weight loss application to the context of its users while retaining an effective degree of automation. The adaptation addressed body image, eating and physical exercise habits, and regional/cultural needs. The paper discusses how surveying potential users can be used to build a profile of a target population, find common patterns, and then develop a database of text messages. The text messages are automated and sent to the users at specific times of day, as suggested by the survey results. Selma Limam Mansar, Shashank Jariwala, Nawal Behih, Maahd Shahzad, and Aysha Anggraini Copyright © 2014 Selma Limam Mansar et al. All rights reserved. A Framework for Sustainable Implementation of E-Medicine in Transitioning Countries Thu, 26 Dec 2013 09:52:33 +0000 Organizations in developed countries such as the United States of America and Canada face difficulties and challenges in technology transfer from one organization to another; the complexity of problems easily compounds when such transfers are attempted from developed to developing countries due to differing socioeconomic and cultural environments. There is a gap in the formation of research and education programs to address technology transfer issues that go beyond just transferring the technologies to sustaining such transfers for longer periods. This study examined telemedicine transfer challenges in three Sub-Sahara African countries and developed a framework for sustainable implementation of e-medicine. Both quantitative and qualitative research methods were used. The study findings indicate that e-medicine sustainability in Sub-Saharan Africa is affected by institutional factors such as institutional environment and knowledge management practices; technical factors such as the technological environment and technology transfer project environment; social environmental factors such as social environment and donor involvement. These factors were used to model the proposed framework. Stephen Robert Isabalija, Victor Mbarika, and Geoffrey Mayoka Kituyi Copyright © 2013 Stephen Robert Isabalija et al. All rights reserved. Assistive/Socially Assistive Robotic Platform for Therapy and Recovery: Patient Perspectives Sun, 22 Dec 2013 15:01:21 +0000 Improving adherence to therapy is a critical component of advancing outcomes and reducing the cost of rehabilitation. A robotic platform was previously developed to explore how robotics could be applied to the social dimension of rehabilitation to improve adherence. This paper aims to report on feedback given by end users of the robotic platform as well as the practical applications that socially assistive robotics could have in the daily life activities of a patient. A group of 10 former and current patients interacted with the developed robotic platform during a simulated exercise session before taking an experience-based survey. A portion of these participants later provided verbal feedback as part of a focus group on the potential utility of such a platform. Identified applications included assistance with reaching exercise goals, managing to-do lists, and supporting participation in social and recreational activities. The study participants expressed that the personality characteristics of the robotic system should be adapted to individual preferences and that the assistance provided over time should align with the progress of their recovery. The results from this study are encouraging and will be useful for further development of socially assistive robotics. Matthew White, Mary Vining Radomski, Marsha Finkelstein, Daniel Allan Samuel Nilsson, and Lars Ingimar Eugen Oddsson Copyright © 2013 Matthew White et al. All rights reserved. Smartphone Medical Applications for Women’s Health: What Is the Evidence-Base and Feedback? Wed, 18 Dec 2013 09:52:44 +0000 Background. Smartphone medical applications have a major role to play in women’s health with their roles being very broad, ranging from improving health behaviours to undertaking personalised tests. Objective(s). Using Medline, Web of Knowledge, and the PRISMA guidelines 15 randomized controlled trials (RCTs) were identified, with mobile interventions being tested on 1603 females, in relation to key aspects of health. Using a similar systematic approach an iPhone database search identified 47 applications (apps) developed to improve women’s health. Findings. Ten RCTs used text messaging or app interventions to support weight loss, with significant improvements being observed in eight studies. For other aspects of women’s health RCTs are needed to determine possible health benefits. iPhone store data analysis identified that a substantial number of women’s health apps did not have star ratings or feedback comments (68 and 49 per cent, resp.), raising concerns about their validity. Conclusion. Peer-review systems, supporting statements of evidence, or certification standards would be beneficial in maintaining the quality and credibility of future health-focused apps. Patient groups should also ideally be involved in the development and testing of mobile medical apps. Emma Derbyshire and Darren Dancey Copyright © 2013 Emma Derbyshire and Darren Dancey. All rights reserved. Evaluation of a Clinical Service Model for Dysphagia Assessment via Telerehabilitation Sun, 08 Dec 2013 11:55:13 +0000 Emerging research supports the feasibility and viability of conducting clinical swallow examinations (CSE) for patients with dysphagia via telerehabilitation. However, minimal data has been reported to date regarding the implementation of such services within the clinical setting or the user perceptions of this type of clinical service. A mixed methods study design was employed to examine the outcomes of a weekly dysphagia assessment clinic conducted via telerehabilitation and examine issues relating to service delivery and user perceptions. Data was collected across a total of 100 patient assessments. Information relating to primary patient outcomes, session statistics, patient perceptions, and clinician perceptions was examined. Results revealed that session durations averaged 45 minutes, there was minimal technical difficulty experienced, and clinical decisions made regarding primary patient outcomes were comparable between the online and face to face clinicians. Patient satisfaction was high and clinicians felt that they developed good rapport, found the system easy to use, and were satisfied with the service in over 90% of the assessments conducted. Key factors relating to screening patient suitability, having good general organization, and skilled staff were identified as facilitators for the service. This trial has highlighted important issues for consideration when planning or implementing a telerehabilitation service for dysphagia management. Elizabeth C. Ward, Clare L. Burns, Deborah G. Theodoros, and Trevor G. Russell Copyright © 2013 Elizabeth C. Ward et al. All rights reserved. mHealth in Sub-Saharan Africa Wed, 04 Dec 2013 14:44:16 +0000 Mobile phone penetration rates have reached 63% in sub-Saharan Africa (SSA) and are projected to pass 70% by 2013. In SSA, millions of people who never used traditional landlines now use mobile phones on a regular basis. Mobile health, or mHealth, is the utilization of short messaging service (SMS), wireless data transmission, voice calling, and smartphone applications to transmit health-related information or direct care. This systematic review analyzes and summarizes key articles from the current body of peer-reviewed literature on PubMed on the topic of mHealth in SSA. Studies included in the review demonstrate that mHealth can improve and reduce the cost of patient monitoring, medication adherence, and healthcare worker communication, especially in rural areas. mHealth has also shown initial promise in emergency and disaster response, helping standardize, store, analyze, and share patient information. Challenges for mHealth implementation in SSA include operating costs, knowledge, infrastructure, and policy among many others. Further studies of the effectiveness of mHealth interventions are being hindered by similar factors as well as a lack of standardization in study design. Overall, the current evidence is not strong enough to warrant large-scale implementation of existing mHealth interventions in SSA, but rapid progress of both infrastructure and mHealth-related research in the region could justify scale-up of the most promising programs in the near future. Thomas J. Betjeman, Samara E. Soghoian, and Mark P. Foran Copyright © 2013 Thomas J. Betjeman et al. All rights reserved. The Anticipated Positive Psychosocial Impact of Present Web-Based E-Health Services and Future Mobile Health Applications: An Investigation among Older Swedes Tue, 03 Dec 2013 13:26:28 +0000 This study investigates the anticipated psychosocial impact of present web-based e-health services and future mobile health applications among older Swedes. Random sample’s of Swedish citizens aged 55 years old and older were given a survey containing two different e-health scenarios which respondents rated according to their anticipated psychosocial impact by means of the PIADS instrument. Results consistently demonstrated the positive anticipation of psychosocial impacts for both scenarios. The future mobile health applications scored more positively than the present web-based e-health services. An increase in age correlated positively to lower impact scores. These findings indicate that from a psychosocial perspective, web-based e-health services and mobile health applications are likely to positively impact quality of life. This knowledge can be helpful when tailoring and implementing e-health services that are directed to older people. S. Wiklund Axelsson, L. Nyberg, A. Näslund, and A. Melander Wikman Copyright © 2013 S. Wiklund Axelsson et al. All rights reserved. Mobile Phone Short Message Service (SMS) for Weight Management in Iranian Overweight and Obese Women: A Pilot Study Tue, 17 Sep 2013 09:42:29 +0000 We conducted a text message-based intervention for weight management over three months by two months intervention and one month wash-out period. In a quasi-experimental study with control () and experimental group (), 80 overweight and obese employed women were entered. Participants were recruited via announcement. All subjects attended a face-to-face information session and received a booklet that contained food calorie chart and strategies and recommendations for weight management. The experimental group received text messages (SMS) about weight management twice a day for two months, in addition to the information and the booklet which they had received in the information session. Also, the experimental group was instructed to weekly self-weight and to send the data to the principle researcher. All subjects were measured for baseline and secondary weight in a standardized manner by a nurse, and the data were compared between the two groups. Experimental group lost more weight than the control group (1.5 kg difference, ). Text messaging seems to be an effective channel of communication for weight management in Iranian overweight and obese women. The clinical trial registration number is IRCT201204029360N1. Somayeh Faghanipour, Eftekharalsadat Hajikazemi, Soghra Nikpour, Shabnam al-Sadat Shariatpanahi, and Agha Fatemeh Hosseini Copyright © 2013 Somayeh Faghanipour et al. All rights reserved. Attracting Child Psychiatrists to a Televideo Consultation Service: The TeleLink Experience Thu, 20 Jun 2013 16:45:14 +0000 Objective. Identify aspects of psychiatry work that are rewarding, as well as those that are challenging, from the perspective of psychiatrists and residents participating in televideo consultation services. Method. A web-based survey was distributed to psychiatrists within the Division of Child Psychiatry at the University of Toronto. Also, semistructured interviews were conducted with six child psychiatrists providing services to a telepsychiatry program. Finally, a focus group interview was held with four psychiatry residents. Results. Child psychiatrists are very comfortable conducting assessments via televideo. Factors identified as being important in the decision to participate in telepsychiatry include assisting underserved communities, supportive administrative staff, enhanced rural provider capacity, financial incentives, and convenience. The study’s qualitative phase identified four themes in the decision to participate in telepsychiatry: (1) organizational, (2) shared values, (3) innovation, and (4) the consultation model. Conclusion. The success of televideo consultation programs in attracting child psychiatrists to provide consultation services to underresourced communities makes an important contribution to psychiatric workforce shortages. Understanding what aspects of telepsychiatry are most appreciated by consulting psychiatrists and residents offers useful strategies to telepsychiatry administrators and medical school educators seeking to attract, train, and retain psychiatry practitioners. Tiziana Volpe, Katherine M. Boydell, and Antonio Pignatiello Copyright © 2013 Tiziana Volpe et al. All rights reserved. Assessing Hospital Readmission Risk Factors in Heart Failure Patients Enrolled in a Telemonitoring Program Sat, 27 Apr 2013 10:29:19 +0000 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. Robust Sounds of Activities of Daily Living Classification in Two-Channel Audio-Based Telemonitoring Mon, 22 Apr 2013 15:20:58 +0000 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.