Medical Quality-of-Service Optimization in Wireless Telemedicine System Using Optimal Smoothing Algorithm

In this paper we consider the transmission of stored video from a server to a client for medical applications such as, Telemonitoring, to optimize medical quality of service (m-QoS) and to examine how the client buffer space can be used efficiently and effectively towards reducing the rate variability of the compressed variable bit rate (VBR) video. Three basic results are presented. First, we show how to obtain the greatest possible reduction in rate variability when sending stored video to client with a given buffer size. Second, how to reduce high peak data rate of compressed VBR video when a patient is moving/walking very fast in hospital. Third, we evaluate the impact of optimal smoothing algorithm on the network parameters such as, peak-to-mean ratio, standard deviation, delay, jitter, average delay and average jitter to optimize the m-QoS. To resolve these all problems we used optimal smoothing algorithm and show its performance over a set of long MPEG-4 encoded video traces. Simulation results show that m-QoS is optimized by minimizing network metrics.

Design and Development of a Two Channel Telemedicine System for Rural Healthcare

In this work, an attempt has been made to design an Electro Cardio Gram (ECG) and Photo Plethysmo Gram (PPG) based telemedicine system for rural health care. In India as per the survey conducted by Indian Medical Society in the year 2009, it has been revealed that only 2% of the qualified doctors practice in rural areas. Also, according to the statistics taken by the World Health Organization, every year an estimated 17 million people die of various cardio vascular diseases. This paper introduces the transmission of ECG and PULSE from remote areas to the specialists’ office. The ECG and PPG signals are acquired, digitized and processed using LabVIEW for detection of heart and pulse rate. These data are transmitted using two methods namely Web publishing tool and Shared Variables. The results confirm the transfer of data with less than millisecond delay.

Telemedicine System Based on Medical Consultation Assistance Integration

With the aging of the global population, how to provide effective telemedicine for the aging population has become a very important issue, especially for the elderly with limited mobility. If there is a complete telemedicine system, it will not only greatly improve medical efficiency. It can reduce the chance of contact between people and avoid the medical risks caused by severe special infectious pneumonia. This paper focuses on the development of a high-efficiency telemedicine system platform that conforms to international standard data exchange formats. This system platform can not only solve the problem of shortage of medical staff but also allow patients to be free from medical outpatient time constraints. Achieve the effect of telemedicine at any time, and digitize the medical process rules to establish a complete online telemedicine system platform.

Intervention effect of telemedicine on ischemic stroke:a systematic review and meta-analysis

Background:Telemedicine refers to the use of information technology by medical institutions to directly provide diagnostic and therapeutic services to patients outside the healthcare facility.It encompasses various aspects such as remote diagnosis,remote monitoring,remote consultation,and remote outpatient services.Numerous articles have evaluated its role in controlling diseases like hypertension,diabetes,atrial fibrillation,and ischemic stroke.However,the existing literature exhibits varying quality and sample sizes,lacking robust convincing power and systematic effectiveness evaluation.Methods:Following The Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 guidelines,we identified articles on remote medical intervention in ischemic stroke through databases including Web of Science,PubMed,EMBASE,Cochrane Library,CNKI,Weipu,and Wanfang.The search spanned from the inception of the databases to June 30,2022.Two researchers independently assessed literature quality,extracted data,and conducted meta-analysis using RevMan 5.3 software.Results:Ten articles,involving 5092 patients,were included.Meta-analysis results indicate that telemedicine can effectively enhance compliance with doctors’advice in ischemic stroke patients.Telemedicine is also associated with reduced stroke recurrence,moderate to severe disability,systolic and diastolic blood pressure,National Institutes of Health Stroke Scale scores,and Modified Rankin Scale scores.Additionally,telemedicine demonstrates effectiveness in improving Fugl-Meyer motor function assessment and the Barthel Index of activity of daily living in ischemic stroke patients.However,telemedicine does not significantly reduce stroke hospitalization in the past year and the death rate.Conclusion:In comparison to traditional healthcare,telemedicine exhibits advantages in improving compliance and enhancing functionality in ischemic stroke patients.It is worth promoting telemedicine for better management of ischemic stroke patients.However,this study does not explain how telemedicine improves the functionality of ischemic stroke patients,indicating a need for further research.

Enhancing diabetic retinopathy screening:Non-mydriatic fundus photography-assisted telemedicine for improved clinical management

The utilization of non-mydriatic fundus photography-assisted telemedicine to screen patients with diabetes mellitus for diabetic retinopathy provides an accurate,efficient,and cost-effective method to improve early detection of disease.It has also been shown to correlate with increased participation of patients in other aspects of diabetes care.In particular,patients who undergo teleretinal imaging are more likely to meet Comprehensive Diabetes Care Healthcare Effectiveness Data and Information Set metrics,which are linked to preservation of quality-adjusted life years and additional downstream healthcare savings.

Application of non-mydriatic fundus photography-assisted telemedicine in diabetic retinopathy screening

BACKGROUND Early screening and accurate staging of diabetic retinopathy(DR)can reduce blindness risk in type 2 diabetes patients.DR’s complex pathogenesis involves many factors,making ophthalmologist screening alone insufficient for prevention and treatment.Often,endocrinologists are the first to see diabetic patients and thus should screen for retinopathy for early intervention.AIM To explore the efficacy of non-mydriatic fundus photography(NMFP)-enhanced telemedicine in assessing DR and its various stages.METHODS This retrospective study incorporated findings from an analysis of 93 diabetic patients,examining both NMFP-assisted telemedicine and fundus fluorescein angiography(FFA).It focused on assessing the concordance in DR detection between these two methodologies.Additionally,receiver operating characteristic(ROC)curves were generated to determine the optimal sensitivity and specificity of NMFP-assisted telemedicine,using FFA outcomes as the standard benchmark.RESULTS In the context of DR diagnosis and staging,the kappa coefficients for NMFPassisted telemedicine and FFA were recorded at 0.775 and 0.689 respectively,indicating substantial intermethod agreement.Moreover,the NMFP-assisted telemedicine’s predictive accuracy for positive FFA outcomes,as denoted by the area under the ROC curve,was remarkably high at 0.955,within a confidence interval of 0.914 to 0.995 and a statistically significant P-value of less than 0.001.This predictive model exhibited a specificity of 100%,a sensitivity of 90.9%,and a Youden index of 0.909.CONCLUSION NMFP-assisted telemedicine represents a pragmatic,objective,and precise modality for fundus examination,particularly applicable in the context of endocrinology inpatient care and primary healthcare settings for diabetic patients.Its implementation in these scenarios is of paramount significance,enhancing the clinical accuracy in the diagnosis and therapeutic management of DR.This methodology not only streamlines patient evaluation but also contributes substantially to the optimization of clinical outcomes in DR management.

Expanding telemedicine to reduce the burden on the healthcare systems and poverty in Africa for a post-coronavirus disease 2019 (COVID-19) pandemic reformation

The coronavirus disease 2019(COVID-19)global public health emergency,has exposed the fragility of health systems.Access to healthcare became a scarce commodity as healthcare providers and resource-poor popula­tions became victims of the novel corona virus.Therefore,this study focuses on Africa’s readiness to integrate telemedicine into the weak health systems and its adoption may help alleviate poor healthcare and poverty after COVID-19.We conducted a narrative review through different search strategies in Scopus on January 20,2021,to identify available literature reporting implementation of various telemedicine modes in Africa from January 1,2011 to December 31,2020.We summarized 54 studies according to geographies,field,and implementation methods.The results show a willingness to adopt telemedicine in the resource-poor settings and hard-to-reach populations,which will bring relief to the inadequate healthcare systems and alleviate poverty of those who feel the burden of healthcare cost the most.With adequate government financing,telemedicine promises to enhance the treating of communicable and non-communicable diseases as well as support health infrastructure.It can also alleviate poverty among vulnerable groups and hard-to-reach communities in Africa with adequate government financing.However,given the lack of funding in Africa,the challenges in implementing telemedicine require global and national strategies before it can yield promising results.This is especially true in regards to alleviating the multidimensionality of poverty in post-COVID-19 Africa.

Telemedicine and digital management in repair and regeneration after nerve injury and in nervous system diseases

To the editor, We read with interest the article, ＂Facilitating transparency in spinal cord injury studies using data standards and ontol- ogles＂ by Professor Vance E Lemmon, University of Miami, USA （Lemmon et al., 2014） and would like to add to the discussion on digital management in spinal cord injury. We have analyzed the advancements in the treatment of spinal cord injury, traumatic brain jury. Encouraging outcomes injury and peripheral nerve in- have been achieved in the area of regulating axon growth in vivo and in vitro. However, such a large amount of information neither provides in-depth insight for other scholars nor provides detailed therapeutic nrotocols for clinical studies.

Application of the Modified Early Obstetric Warning System in Three Patients with Obstetric Sepsis Through a Telemedicine System

To editor:Maternal sepsis represents the third cause of maternal mortality worldwide and the diagnosis delay portrays a great contribution due to its high lethality.The Modified Early Obstetric Warning System is an early detection tool validated in maternal sepsis scenarios.

Knowledge and Attitude of Salesmen in Nigeria towards Telemedicine

Need for prompt access to healthcare led to this cross-sectional study aimed to determine the knowledge and attitude of Sales men in Nigeria. It involved 362 Salesmen from some selected big companies in three states (Taraba, Benue and Adamawa) and Abuja. An electronic survey prepared using Google Form was used to collect information through social media such as WhatsApp. The research tool was validated by three experts in public health and the reliability test was done using Cronbach Alpha and a 0.7 co-efficient was obtained. The findings from the study revealed that 98.1% respondents have heard about telemedicine while 98.1% agreed that mobile health can help especially during emergency. However, 97.2% knew telemedicine involves Live consultation and interactive sessions from a distance. Nevertheless, 95.9% knew telemedicine makes it possible for one to access clinical services from a distance while 93.4% were aware that telemedicine has provision for storage and forwarding, 82.9% knew telemedicine makes it possible for one to easily reach medical specialists. On their attitudes towards telemedicine, 49.7% and 49.4% of the respondents strongly agreed and agreed respectively that telemedicine makes it easier for one to reach his doctor while 42% and 49.4% agreed and strongly agreed that telemedicine helps to curb the spread of infection. However, 47% and 49.7% respectively agreed and strongly agreed that telemedicine enables one to receive medical attention even at odd hours or while in remote villages. Meanwhile, 42% and 49.4% respectively agreed and strongly agreed that telemedicine reduces cost. Also, 44.2% and 51.9% of the respondents respectively agreed and strongly agreed that telemedicine offers appropriate medical follow-up. Nevertheless, 43.6% of the respondents agreed while 52.8% strongly agreed that telemedicine offers medical attention while one is in the comfort of his home. Finally, 45% and 47% of the participants respectively agreed and strongly agreed that with telemedicine one does not need to waste a whole day of work just to receive medical attention. In conclusion, the knowledge of telemedicine was high (82.9%) among the Salesmen while the attitude reflected high (93.6%) acceptance. Therefore, there is a need to introduce the use of telemedicine Apps to the Salesmen and also subsidize the applications.

Telemedicine in inflammatory bowel diseases:A new brick in the medicine of the future?

Inflammatory bowel disease(IBD)is a chronic digestive disease that requires continuous monitoring by healthcare professionals to determine the appropriate therapy and monitor short-term and long-term complications.The progressive development of information technology has enabled healthcare personnel to deliver care services to patients remotely.Therefore,various applications of telemedicine in IBD management have evolved,including telemonitoring,teleconsulting,teleducation,telenursing,telenutrition,and telepathology.While evidence has been provided for some telemedicine applications,targeted studies are still required.This review summarises the major studies that have evaluated telemedicine and its application in the management of IBD.

Telemedicine and Smart Healthcare—The Role of Artificial Intelligence, 5G, Cloud Services, and Other Enabling Technologies

This paper discusses telemedicine and the employment of advanced mobile technologies in smart healthcare delivery. It covers the technological advances in connected smart healthcare, including the roles of artificial intelligence, machine learning, 5G and IoT platforms, and other enabling technologies. It also presents the challenges and potential risks that could arise from delivering connected smart healthcare services. Healthcare delivery is witnessing revolutions engineered by the developments in mobile connectivity and the plethora of platforms, applications, sensors, devices, and equipment that go along with it. Human society is evolving fast in response to these technological developments, which are also pushing the connectivity-providing sector to create and adopt new waves of network technologies. Consequently, new communications technologies have been introduced into the healthcare system and many novel applications have been developed to make it easier for sharing data in various forms and volumes within health-related services. These applications have also made it possible for telemedicine to be effectively adopted. This paper provides an overview of some of the recent developments within the space of mobile connectivity and telemedicine.

21st century critical care medicine:An overview

Critical care medicine in the 21st century has witnessed remarkable advancements that have significantly improved patient outcomes in intensive care units(ICUs).This abstract provides a concise summary of the latest developments in critical care,highlighting key areas of innovation.Recent advancements in critical care include Precision Medicine:Tailoring treatments based on individual patient characteristics,genomics,and biomarkers to enhance the effectiveness of therapies.The objective is to describe the recent advancements in Critical Care Medicine.Telemedicine:The integration of telehealth technologies for remote patient monitoring and consultation,facilitating timely interventions.Artificial intelligence(AI):AI-driven tools for early disease detection,predictive analytics,and treatment optimization,enhancing clinical decision-making.Organ Support:Advanced life support systems,such as Extracorporeal Membrane Oxygenation and Continuous Renal Replacement Therapy provide better organ support.Infection Control:Innovative infection control measures to combat emerging pathogens and reduce healthcare-associated infections.Ventilation Strategies:Precision ventilation modes and lung-protective strategies to minimize ventilatorinduced lung injury.Sepsis Management:Early recognition and aggressive management of sepsis with tailored interventions.Patient-Centered Care:A shift towards patient-centered care focusing on psychological and emotional wellbeing in addition to medical needs.We conducted a thorough literature search on PubMed,EMBASE,and Scopus using our tailored strategy,incorporating keywords such as critical care,telemedicine,and sepsis management.A total of 125 articles meeting our criteria were included for qualitative synthesis.To ensure reliability,we focused only on articles published in the English language within the last two decades,excluding animal studies,in vitro/molecular studies,and non-original data like editorials,letters,protocols,and conference abstracts.These advancements reflect a dynamic landscape in critical care medicine,where technology,research,and patient-centered approaches converge to improve the quality of care and save lives in ICUs.The future of critical care promises even more innovative solutions to meet the evolving challenges of modern medicine.

Robust Reversible Audio Watermarking Scheme for Telemedicine and Privacy Protection

The leakage of medical audio data in telemedicine seriously violates the privacy of patients.In order to avoid the leakage of patient information in telemedicine,a two-stage reversible robust audio watermarking algorithm is proposed to protect medical audio data.The scheme decomposes the medical audio into two independent embedding domains,embeds the robust watermark and the reversible watermark into the two domains respectively.In order to ensure the audio quality,the Hurst exponent is used to find a suitable position for watermark embedding.Due to the independence of the two embedding domains,the embedding of the second-stage reversible watermark will not affect the first-stage watermark,so the robustness of the first-stage watermark can be well maintained.In the second stage,the correlation between the sampling points in the medical audio is used to modify the hidden bits of the histogram to reduce the modification of the medical audio and reduce the distortion caused by reversible embedding.Simulation experiments show that this scheme has strong robustness against signal processing operations such as MP3 compression of 48 db,additive white Gaussian noise(AWGN)of 20 db,low-pass filtering,resampling,re-quantization and other attacks,and has good imperceptibility.

Improving cirrhosis care: The potential for telemedicine and mobile health technologies

Decompensated cirrhosis is a condition associated with significant morbidity and mortality. While there have been significant efforts to develop quality metrics that ensure high-value care of these patients, wide variations in clinical practice exist. In this opinion review, we discuss the quality gap in the care of patients with cirrhosis, including low levels of compliance with recommended cancer screening and other clinical outcome and patient-reported outcome measures. We posit that innovations in telemedicine and mobile health (mHealth) should play a key role in closing the quality gaps in liver disease management. We highlight interventions that have been performed to date in liver disease and heart failurefrom successful teleconsultation interventions in the care of veterans with cirrhosis to the use of telemonitoring to reduce hospital readmissions and decrease mortality rates in heart failure. Telemedicine and mHealth can effectively address unmet needs in the care of patients with cirrhosis by increasing preventative care, expanding outreach to rural communities, and increasing high-value care. We aim to highlight the benefits of investing in innovative solutions in telemedicine and mHealth to improve care for patients with cirrhosis and create downstream cost savings.

Efficacy of telemedicine on glycaemic control in patients with type 2 diabetes:A meta-analysis

BACKGROUND Telemedicine is defined as the delivery of health services via remote communication and technology.It is a convenient and cost-effective method of intervention,which has shown to be successful in improving glyceamic control for type 2 diabetes patients.The utility of a successful diabetes intervention is vital to reduce disease complications,hospital admissions and associated economic costs.AIM To evaluate the effects of telemedicine interventions on hemoglobin A1c(HbA1c),systolic blood pressure(SBP),diastolic blood pressure(DBP),body mass index(BMI),post-prandial glucose(PPG),fasting plasma glucose(FPG),weight,cholesterol,mental and physical quality of life(QoL)in patients with type 2 diabetes.The secondary aim of this study is to determine the effect of the following subgroups on HbA1c post-telemedicine intervention;telemedicine characteristics,patient characteristics and self-care outcomes.METHODS PubMed Central,Cochrane Library,Embase and Scopus databases were searched from inception until 18th of June 2020.The quality of the 43 included studies were assessed using the PEDro scale,and the random effects model was used to estimate outcomes and I2 for heterogeneity testing.The mean difference and standard deviation data were extracted for analysis.RESULTS We found a significant reduction in HbA1c[-0.486%;95%confidence interval(CI)-0.561 to-0.410,P<0.001],DBP(-0.875 mmHg;95%CI-1.429 to-0.321,P<0.01),PPG(-1.458 mmol/L;95%CI-2.648 to-0.268,P<0.01),FPG(-0.577 mmol/L;95%CI-0.710 to-0.443,P<0.001),weight(-0.243 kg;95%CI-0.442 to-0.045,P<0.05),BMI(-0.304;95%CI-0.563 to-0.045,P<0.05),mental QoL(2.210;95%CI 0.053 to 4.367,P<0.05)and physical QoL(-1.312;95%CI 0.545 to 2.080,P<0.001)for patients following telemedicine interventions in comparison to control groups.The results of the meta-analysis did not show any significant reductions in SBP and cholesterol in the telemedicine interventions compared to the control groups.The telemedicine characteristic subgroup analysis revealed that clinical treatment models of intervention,as well as those involving telemonitoring,and those provided via modes of videoconference or interactive telephone had the greatest effect on HbA1c reduction.In addition,interventions delivered at a less than weekly frequency,as well as those given for a duration of 6 mo,and those lead by allied health resulted in better HbA1c outcomes.Furthermore,interventions with a focus on biomedical parameters,as well as those with an engagement level>70%and those with a drop-out rate of 10%-19.9%showed greatest HbA1c reduction.The patient characteristics investigation reported that Hispanic patients with T2DM had a greater HbA1c reduction post telemedicine intervention.For self-care outcomes,telemedicine interventions that resulted in higher postintervention glucose monitoring and self-efficacy were shown to have better HbA1c reduction.CONCLUSION The findings indicate that telemedicine is effective for improving HbA1c and thus,glycemic control in patients with type 2 diabetes.In addition,telemedicine interventions were also found to significantly improved other health outcomes as well as QoL scores.The results of the subgroup analysis emphasized that interventions in the form of telemonitoring,via a clinical treatment model and with a focus on biomedical parameters,delivered at a less than weekly frequency and 6 mo duration would have the largest effect on HbA1c reduction.This is in addition to being led by allied health,through modes such as video conference and interactive telephone,with an intervention engagement level>70%and a drop-out rate between 10%-19.9%.Due to the high heterogeneity of included studies and limitations,further studies with a larger sample size is needed to confirm our findings.

Importance of telemedicine in diabetes care: Relationships between family physicians and ophthalmologists

Diabetic retinopathy(DR) is the worldwide leading cause of legal blindness. In 2010, 1.9% of diabetes mellitus(DM) patients were legally blind and 10.2% had visual impairment. The control of DM parameters(glycemia, arterial tension and lipids) is the gold standard for preventing DR complications, although, unfortunately, DR still appeared in a 25% to 35% of patients. The stages of severe vision threading DR, include proliferative DR(6.96%) and diabetic macular edema(6.81%). This review aims to update our knowledge on DR screening using telemedicine, the different techniques, the problems, and the inclusion of different professionals such as family physicians in care programs.

COVID-19 pandemic:usefulness of telemedicine in management of arrhythmias in elderly people

In March 2020,the WHO defined the diffusion of novel coronavirus,Severe Acute Respiratory Syndrome-Coronavirus-2(SARS-CoV-2)as pandemic.[1-3]As a consequence,the Italian Government among others has enforced quarantine on the population to contain the diffusion of the infection.Quarantine refers to the separation of communities who have been exposed to an infectious disease.[1-3]Elderly people's lives have been drastically affected by the lockdown and the fear related to the disease’s potential effects and transmission.Fear of contracting COVID-19 is on the rise due to the death toll and alarming news reports in the media.[2,3].

mHealth as a health system strengthening tool in China

Over the past 70 years,there was a rapid epidemiological transition in disease burden in China,from infectious disease to non-communicable diseases(NCDs),which requires long-term prevention and management.Rapid growth in mobile phone use,internet connectivity and digital health technology,presents new opportunities for improvement in NCD healthcare delivery and population-based outcomes.Although there were a growing number of research to evaluate the feasibility and effectiveness of the mobile health(mHealth)interventions for NCD management,the extent to which mHealth contributes towards the health system strengthening in China remains unknown.In this paper,we provided a high-level overview of mHealth in China and its role for Chinese health system strengthening.We conclude with several recommendations for the future of mHealth research in China based on existing evidence identified.

Suitability of VVC and HEVC for Video Telehealth Systems

Video compression in medical video streaming is one of the key technologies associated with mobile healthcare.Seamless delivery of medical video streams over a resource constrained network emphasizes the need of a video codec that requires minimum bitrates and maintains high perceptual quality.This paper presents a comparative study between High Efciency Video Coding(HEVC)and its potential successor Versatile Video Coding(VVC)in the context of healthcare.A large-scale subjective experiment comprising of twenty-four non-expert participants is presented for eight different test conditions in Full High Denition(FHD)videos.The presented analysis highlights the impact of compression artefacts on the perceptual quality of HEVC and VVC processed videos.Our results and ndings show that VVC clearly outperforms HEVC in terms of achieving higher compression,while maintaining high quality in FHD videos.VVC requires upto 40%less bitrate for encoding an FHD video at excellent perceptual quality.We have provided rate-quality curves for both encoders and a degree of overlap across both codecs in terms of perceptual quality.Overall,there is a 71%degree of overlap in terms of quality between VVC and HEVC compressed videos for eight different test conditions.