International Journal of Telemedicine and Applications The latest articles from Hindawi © 2017 , Hindawi Limited . All rights reserved. Do Face-to-Face Training and Telephonic Reminder Improve Dry Powder Inhaler Technique in Patients with COPD? Mon, 13 Mar 2017 10:25:30 +0000 Introduction. Current modes of instruction on inhaler technique are inadequate. We aimed to evaluate the value of face-to-face training and telephonic reminder (FFTTR) for improving Rotahaler technique in experienced patients with COPD. Materials and Methods. A single group pre-/postinterventional study was conducted at Chitwan Medical College Teaching Hospital, Nepal. We assessed the Rotahaler technique of thirty consecutive patients using Rotahaler device for more than one year. Patients with incorrect technique () were instructed and trained by a pharmacist. Telephonic reminder was used to reinstruct patients on the correct technique on weekly basis for two weeks and technique was reassessed after 4 weeks of their first training. Descriptive statistics including Wilcoxon Signed Rank test were applied. Results. The mean age was Of 30 patients, 10 (33.3%) performed Rotahaler technique correctly at baseline and were excluded from FFTTR intervention. FFTTR corrected the technique in 18 (90%) patients and the median (IQR) score increased from 6 (5-6) to 8 (8-8) (). The most incorrect steps were “breathe out gently but not towards the inhaler mouthpiece” (16, 80%) and “hold breath for about 10 seconds” (18, 90%) at baseline which improved after intervention. Conclusion. FFTTR approach markedly improved Rotahaler technique in patients with COPD. Ramesh Sharma Poudel, Shakti Shrestha, Pawan Bhatta, and Rano Mal Piryani Copyright © 2017 Ramesh Sharma Poudel et al. All rights reserved. Clinical Decision Support Systems for Comorbidity: Architecture, Algorithms, and Applications Wed, 08 Mar 2017 07:59:07 +0000 In this paper, we present the design of a clinical decision support system (CDSS) for monitoring comorbid conditions. Specifically, we address the architecture of a CDSS by characterizing it from three layers and discuss the algorithms in each layer. Also we address the applications of CDSSs in a few real scenarios and analyze the accuracy of a CDSS in consideration of the potential conflicts when using multiple clinical practice guidelines concurrently. Finally, we compare the system performance in our design with that in the other design schemes. Our study shows that our proposed design can achieve a clinical decision in a shorter time than the other designs, while ensuring a high level of system accuracy. Aihua Fan, Di Lin, and Yu Tang Copyright © 2017 Aihua Fan et al. All rights reserved. Research on Optimization of Pooling System and Its Application in Drug Supply Chain Based on Big Data Analysis Wed, 15 Feb 2017 00:00:00 +0000 Reform of drug procurement is being extensively implemented and expanded in China, especially in today’s big data environment. However, the pattern of supply mode innovation lags behind procurement improvement. Problems in financial strain and supply break frequently occur, which affect the stability of drug supply. Drug Pooling System is proposed and applied in a few pilot cities to resolve these problems. From the perspective of supply chain, this study analyzes the process of setting important parameters and sets out the tasks of involved parties in a pooling system according to the issues identified in the pilot run. The approach is based on big data analysis and simulation using system dynamic theory and modeling of Vensim software to optimize system performance. This study proposes a theoretical framework to resolve problems and attempts to provide a valuable reference for future application of pooling systems. DengFeng Wu and Hongyi Mao Copyright © 2017 DengFeng Wu and Hongyi Mao. All rights reserved. A Way to Understand Inpatients Based on the Electronic Medical Records in the Big Data Environment Thu, 09 Feb 2017 00:00:00 +0000 In recent decades, information technology in healthcare, such as Electronic Medical Record (EMR) system, is potential to improve service quality and cost efficiency of the hospital. The continuous use of EMR systems has generated a great amount of data. However, hospitals tend to use these data to report their operational efficiency rather than to understand their patients. Base on a dataset of inpatients’ medical records from a Chinese general public hospital, this study applies a configuration analysis from a managerial perspective and explains inpatients management in a different way. Four inpatient configurations (valued patients, managed patients, normal patients, and potential patients) are identified by the measure of the length of stay and the total hospital cost. The implications of the finding are discussed. Hongyi Mao and Yang Sun Copyright © 2017 Hongyi Mao and Yang Sun. All rights reserved. Real-Time Fall Risk Assessment Using Functional Reach Test Tue, 10 Jan 2017 00:00:00 +0000 Falls are common and dangerous for survivors of stroke at all stages of recovery. The widespread need to assess fall risk in real time for individuals after stroke has generated emerging requests for a reliable, inexpensive, quantifiable, and remote clinical measure/tool. In order to meet these requests, we explore the Functional Reach Test (FRT) for real-time fall risk assessment and implement the FRT function in mStroke, a real-time and automatic mobile health system for poststroke recovery and rehabilitation. mStroke is designed, developed, and delivered as an Application (App) running on a hardware platform consisting of an iPad and one or two wireless body motion sensors based on different mobile health functions. The FRT function in mStroke is extensively tested on healthy human subjects to verify its concept and feasibility. Preliminary performance will be presented to justify the further exploration of the FRT function in mStroke through clinical trials on individuals after stroke, which may guide its ubiquitous exploitation in the near future. Brian Williams, Brandon Allen, Zhen Hu, Hanna True, Jin Cho, Austin Harris, Nancy Fell, and Mina Sartipi Copyright © 2017 Brian Williams et al. All rights reserved. How Environmental Uncertainty Moderates the Effect of Relative Advantage and Perceived Credibility on the Adoption of Mobile Health Services by Chinese Organizations in the Big Data Era Sun, 25 Dec 2016 12:08:59 +0000 Despite the importance of adoption of mobile health services by an organization on the diffusion of mobile technology in the big data era, it has received minimal attention in literature. This study investigates how relative advantage and perceived credibility affect an organization’s adoption of mobile health services, as well as how environmental uncertainty changes the relationship of relative advantage and perceived credibility with adoption. A research model that integrates relative advantage, perceived credibility, environmental uncertainty, and an organization’s intention to use mobile health service is developed. Quantitative data are collected from senior managers and information systems managers in 320 Chinese healthcare organizations. The empirical findings show that while relative advantage and perceived credibility both have positive effects on an organization’s intention to use mobile health services, relative advantage plays a more important role than perceived credibility. Moreover, environmental uncertainty positively moderates the effect of relative advantage on an organization’s adoption of mobile health services. Thus, mobile health services in environments characterized with high levels of uncertainty are more likely to be adopted because of relative advantage than in environments with low levels of uncertainty. Xing Chen and Xing Zhang Copyright © 2016 Xing Chen and Xing Zhang. All rights reserved. Qualitative Assessment of the Feasibility, Usability, and Acceptability of a Mobile Client Data App for Community-Based Maternal, Neonatal, and Child Care in Rural Ghana Wed, 14 Dec 2016 11:51:58 +0000 Mobile phone applications may enhance the delivery of critical health services and the accuracy of health service data. Yet, the opinions and experiences of frontline health workers on using mobile apps to track pregnant and recently delivered women are underreported. This evaluation qualitatively assessed the feasibility, usability, and acceptability of a mobile Client Data App for maternal, neonatal, and child client data management by community health nurses (CHNs) in rural Ghana. The mobile app enabled CHNs to enter, summarize, and query client data. It also sent visit reminders for clients and provided a mechanism to report level of care to district officers. Fourteen interviews and two focus groups with CHNs, midwives, and district health officers were conducted, coded, and thematically analyzed. Results indicated that the app was easily integrated into care, improved CHN productivity, and was acceptable due to its capacity to facilitate client follow-up, data reporting, and decision-making. However, the feasibility and usability of the app were hindered by high client volumes, staff shortages, and software and device challenges. Successful integration of mobile client data apps for frontline health workers in rural and resource-poor settings requires real-time monitoring, program investments, and targeted changes in human resources. Jessica D. Rothstein, Larissa Jennings, Anitha Moorthy, Fan Yang, Lisa Gee, Karen Romano, David Hutchful, Alain B. Labrique, and Amnesty E. LeFevre Copyright © 2016 Jessica D. Rothstein et al. All rights reserved. An Iterative, Mixed Usability Approach Applied to the Telekit System from the Danish TeleCare North Trial Wed, 16 Nov 2016 08:34:34 +0000 Objective. The aim of the present study is to evaluate the usability of the telehealth system, coined Telekit, by using an iterative, mixed usability approach. Materials and Methods. Ten double experts participated in two heuristic evaluations (HE1, HE2), and 11 COPD patients attended two think-aloud tests. The double experts identified usability violations and classified them into Jakob Nielsen’s heuristics. These violations were then translated into measurable values on a scale of 0 to 4 indicating degree of severity. In the think-aloud tests, COPD participants were invited to verbalise their thoughts. Results. The double experts identified 86 usability violations in HE1 and 101 usability violations in HE2. The majority of the violations were rated in the 0–2 range. The findings from the think-aloud tests resulted in 12 themes and associated examples regarding the usability of the Telekit system. The use of the iterative, mixed usability approach produced both quantitative and qualitative results. Conclusion. The iterative, mixed usability approach yields a strong result owing to the high number of problems identified in the tests because the double experts and the COPD participants focus on different aspects of Telekit’s usability. This trial is registered with, NCT01984840, November 14, 2013. Pernille Heyckendorff Lilholt, Clara Schaarup, and Ole Kristian Hejlesen Copyright © 2016 Pernille Heyckendorff Lilholt et al. All rights reserved. Noninferiority and Equivalence Evaluation of Clinical Performance among Computed Radiography, Film, and Digitized Film for Telemammography Services Thu, 29 Sep 2016 08:35:41 +0000 Objective. The aim of this study was to evaluate and compare the clinical performance of different alternatives to implement low-cost screening telemammography. We compared computed radiography, film printed images, and digitized films produced with a specialized film digitizer and a digital camera. Material and Methods. The ethics committee of our institution approved this study. We assessed the equivalence of the clinical performance of observers for cancer detection. The factorial design included 70 screening patients, four technological alternatives, and cases interpreted by seven radiologists, for a total of 1,960 observations. The variables evaluated were the positive predictive value (PPV), accuracy, sensitivity, specificity, and the area under the receiver operating characteristic curves (AUC). Result. The mean values for the observed variables were as follows: accuracy ranged from 0.77 to 0.82, the PPV ranged from 0.67 to 0.68, sensitivity ranged from 0.64 to 0.74, specificity ranged from 0.87 to 0.90, and the AUC ranged from 0.87 to 0.90. At a difference of 0.1 to claim equivalence, all alternatives were equivalent for all variables. Conclusion. Our findings suggest that telemammography screening programs may be provided to underserved populations at a low cost, using a film digitizer or a digital camera. Antonio J. Salazar, Javier A. Romero, Oscar A. Bernal, Angela P. Moreno, Sofía C. Velasco, and Xavier A. Díaz Copyright © 2016 Antonio J. Salazar et al. All rights reserved. The Self-Perception and Usage of Medical Apps amongst Medical Students in the United States: A Cross-Sectional Survey Mon, 05 Sep 2016 11:42:35 +0000 Background. Mobile medical software applications (apps) are used for clinical decision-making at the point of care. Objectives. To determine (1) the usage, reliability, and popularity of mobile medical apps and (2) medical students’ perceptions of app usage effect on the quality of patient-provider interaction in healthcare settings. Methods. An anonymous web-based survey was distributed to medical students. Frequency of use, type of app used, and perceptions of reliability were assessed via univariate analysis. Results. Seven hundred thirty-one medical students responded, equating to a response rate of 29%. The majority (90%) of participants thought that medical apps enhance clinical knowledge, and 61% said that medical apps are as reliable as textbooks. While students thought that medical apps save time, improve the care of their patients, and improve diagnostic accuracy, 53% of participants believed that mobile device use in front of colleagues and patients makes one appear less competent. Conclusion. While medical students believe in the utility and reliability of medical apps, they were hesitant to use them out of fear of appearing less engaged. Higher levels of training correlated with a greater degree of comfort when using medical apps in front of patients. Cara Quant, Lisa Altieri, Juan Torres, and Noah Craft Copyright © 2016 Cara Quant et al. All rights reserved. Continuing Medical Education via Telemedicine and Sustainable Improvements to Health Wed, 31 Aug 2016 14:32:35 +0000 Background. This research aims to investigate the quantitative relationship between telemedicine and online continuing medical education (CME) and to find the optimal CME lectures to be delivered via telemedicine to improve the population’s health status. Objective. This study examines the following: What factors foster learning processes in CME via telemedicine? What is the possible role of online CME in health improvement? And How optimal learning processes can be integrated with various health services? Methods. By applying telemedicine experiences in Taiwan over the period 1995–2004, this study uses panel data and the method of ordinary least squares to embed an adequate set of phenomena affecting the provision of online CME lectures versus health status. Results. Analytical results find that a nonlinear online CME-health nexus exists. Increases in the provision of online CME lectures are associated with health improvements. However, after the optimum has been reached, greater provision of online CME lectures may be associated with decreasing population health. Conclusion. Health attainment could be partially viewed as being determined by the achievement of the appropriately providing online CME lectures. This study has evaluated the population’s health outcomes and responded to the currently inadequate provision of online CME lectures via telemedicine. Fuhmei Wang Copyright © 2016 Fuhmei Wang. All rights reserved. Economic Modeling of Heart Failure Telehealth Programs: When Do They Become Cost Saving? Tue, 26 Jul 2016 13:08:55 +0000 Telehealth programs for congestive heart failure have been shown to be clinically effective. This study assesses clinical and economic consequences of providing telehealth programs for CHF patients. A Markov model was developed and presented in the context of a home-based telehealth program on CHF. Incremental life expectancy, hospital admissions, and total healthcare costs were examined at periods ranging up to five years. One-way and two-way sensitivity analyses were also conducted on clinical performance parameters. The base case analysis yielded cost savings ranging from 2832 to 5499 and 0.03 to 0.04 life year gain per patient over a 1-year period. Applying telehealth solution to a low-risk cohort with no prior admission history would result in 2502 cost increase per person over the 1-year time frame with 0.01 life year gain. Sensitivity analyses demonstrated that the cost savings were most sensitive to patient risk, baseline cost of hospital admission, and the length-of-stay reduction ratio affected by the telehealth programs. In sum, telehealth programs can be cost saving for intermediate and high risk patients over a 1- to 5-year window. The results suggested the economic viability of telehealth programs for managing CHF patients and illustrated the importance of risk stratification in such programs. Sheena Xin Liu, Rui Xiang, Charles Lagor, Nan Liu, and Kathleen Sullivan Copyright © 2016 Sheena Xin Liu et al. All rights reserved. Evaluation of a Scalable Information Analytics System for Enhanced Situational Awareness in Mass Casualty Events Tue, 28 Jun 2016 06:25:14 +0000 We investigate the utility of DIORAMA-II system which provides enhanced situational awareness within a disaster scene by using real-time visual analytics tools and a collaboration platform between the incident commander and the emergency responders. Our trials were conducted in different geographical areas (feature-rich and featureless regions) and in different lighting conditions (daytime and nighttime). DIORAMA-II obtained considerable time gain in efficiency compared to conventional paper based systems. DIORAMA-II time gain was reflected in reduction of both average triage time per patient (up to 34.3% average triage time reduction per patient) and average transport time per patient (up to 76.3% average transport time reduction per red patient and up to 66.3% average transport time reduction per yellow patient). In addition, DIORAMA-II ensured that no patients were left behind or transported in the incorrect order compared to the conventional method which resulted in patients being left behind and transported in the incorrect order. Aura Ganz, James M. Schafer, Zhuorui Yang, Jun Yi, Graydon Lord, and Gregory Ciottone Copyright © 2016 Aura Ganz et al. 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.