Mobile Health in Remote Patient Monitoring for Chronic Diseases: Principles, Trends, and Challenges

Chronic diseases are becoming more widespread. Treatment and monitoring of these diseases require going to hospitals frequently, which increases the burdens of hospitals and patients. Presently, advancements in wearable sensors and communication protocol contribute to enriching the healthcare system in a way that will reshape healthcare services shortly. Remote patient monitoring (RPM) is the foremost of these advancements. RPM systems are based on the collection of patient vital signs extracted using invasive and noninvasive techniques, then sending them in real-time to physicians. These data may help physicians in taking the right decision at the right time. The main objective of this paper is to outline research directions on remote patient monitoring, explain the role of AI in building RPM systems, make an overview of the state of the art of RPM, its advantages, its challenges, and its probable future directions. For studying the literature, five databases have been chosen (i.e., science direct, IEEE-Explore, Springer, PubMed, and science.gov). We followed the (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) PRISMA, which is a standard methodology for systematic reviews and meta-analyses. A total of 56 articles are reviewed based on the combination of a set of selected search terms including RPM, data mining, clinical decision support system, electronic health record, cloud computing, internet of things, and wireless body area network. The result of this study approved the effectiveness of RPM in improving healthcare delivery, increase diagnosis speed, and reduce costs. To this end, we also present the chronic disease monitoring system as a case study to provide enhanced solutions for RPMsThis research work was partially supported by the Sejong University Research Faculty Program (20212023)S

Covid-19 and diabetes

Diabetes mellitus (DM) is one of the most common comorbid conditions in persons with COVID-19 and a risk factor for poor prognosis. The reasons why COVID-19 is more severe in persons with DM are currently unknown although the scarce data available on patients with DM hospitalized because of COVID-19 show that glycemic control is inadequate. The fact that patients with COVID-19 are usually cared for by health professionals with limited experience in the management of diabetes and the need to prevent exposure to the virus may also be obstacles to glycemic control in patients with COVID-19. Effective clinical care should consider various aspects, including screening for the disease in at-risk persons, education, and monitoring of control and complications. We examine the effect of COVID-19 on DM in terms of glycemic control and the restrictions arising from the pandemic and assess management of diabetes and drug therapy in various scenarios, taking into account factors such as physical exercise, diet, blood glucose monitoring, and phar-macological treatment. Specific attention is given to patients who have been admitted to hospital and critically ill patients. Finally, we consider the role of telemedicine in the management of DM patients with COVID-19 during the pandemic and in the future

Continuous Glucose Monitors and Automated Insulin Dosing Systems in the Hospital Consensus Guideline.

This article is the work product of the Continuous Glucose Monitor and Automated Insulin Dosing Systems in the Hospital Consensus Guideline Panel, which was organized by Diabetes Technology Society and met virtually on April 23, 2020. The guideline panel consisted of 24 international experts in the use of continuous glucose monitors (CGMs) and automated insulin dosing (AID) systems representing adult endocrinology, pediatric endocrinology, obstetrics and gynecology, advanced practice nursing, diabetes care and education, clinical chemistry, bioengineering, and product liability law. The panelists reviewed the medical literature pertaining to five topics: (1) continuation of home CGMs after hospitalization, (2) initiation of CGMs in the hospital, (3) continuation of AID systems in the hospital, (4) logistics and hands-on care of hospitalized patients using CGMs and AID systems, and (5) data management of CGMs and AID systems in the hospital. The panelists then developed three types of recommendations for each topic, including clinical practice (to use the technology optimally), research (to improve the safety and effectiveness of the technology), and hospital policies (to build an environment for facilitating use of these devices) for each of the five topics. The panelists voted on 78 proposed recommendations. Based on the panel vote, 77 recommendations were classified as either strong or mild. One recommendation failed to reach consensus. Additional research is needed on CGMs and AID systems in the hospital setting regarding device accuracy, practices for deployment, data management, and achievable outcomes. This guideline is intended to support these technologies for the management of hospitalized patients with diabetes

Cloud-assisted body area networks: state-of-the-art and future challenges

Body area networks (BANs) are emerging as enabling technology for many human-centered application domains such as health-care, sport, fitness, wellness, ergonomics, emergency, safety, security, and sociality. A BAN, which basically consists of wireless wearable sensor nodes usually coordinated by a static or mobile device, is mainly exploited to monitor single assisted livings. Data generated by a BAN can be processed in real-time by the BAN coordinator and/or transmitted to a server-side for online/offline processing and long-term storing. A network of BANs worn by a community of people produces large amount of contextual data that require a scalable and efficient approach for elaboration and storage. Cloud computing can provide a flexible storage and processing infrastructure to perform both online and offline analysis of body sensor data streams. In this paper, we motivate the introduction of Cloud-assisted BANs along with the main challenges that need to be addressed for their development and management. The current state-of-the-art is overviewed and framed according to the main requirements for effective Cloud-assisted BAN architectures. Finally, relevant open research issues in terms of efficiency, scalability, security, interoperability, prototyping, dynamic deployment and management, are discussed

Relay-enabled task offloading management for wireless body area networks

Inspired by the recent developments of the Internet of Things (IoT) relay and mobile edge computing (MEC), a hospital/home-based medical monitoring framework is proposed, in which the intensive computing tasks from the implanted sensors can be efficiently executed by on-body wearable devices or a coordinator-based MEC (C-MEC). In this paper, we first propose a wireless relay-enabled task offloading mechanism that consists of a network model and a computation model. Moreover, to manage the computation resources among all relays, a task offloading decision model and the best task offloading recipient selection function is given. The performance evaluation considers different computation schemes under the predetermined link quality condition regarding the selected vital quality of service (QoS) metrics. After demonstrating the channel characterization and network topology, the performance evaluation is implemented under different scenarios regarding the network lifetime of all relays, network residual energy status, total number of locally executed packets, path loss (PL), and service delay. The results show that data transmission without the offloading scheme outperforms the offload-based technique regarding network lifetime. Moreover, the high computation capacity scenario achieves better performance regarding PL and the total number of locally executed packets

Implementation of a Postdischarge Virtual Visit and Nurse Follow-up Protocol to Decrease 30-Day Readmission Rates for Patients with Pulmonary Arterial Hypertension

Pulmonary arterial hypertension (PAH) is a rare, chronic disease with no cure. Patients with this disease have high mortality and morbidity, experience frequent hospitalizations, readmissions, and psychosocial burdens, and require a high degree of self-care management skills (Doyle-Cox et al., 2016; Lattimer et al., 2016; McDevitt & Walter, 2019). More than half of PAH patients are hospitalized within the first year following diagnosis, and about 20% are readmitted to the hospital within thirty days of discharge (Bhattacharya et al., 2019: Tonelli, 2020). These patients also have a high symptom burden, and these symptoms significantly affect their physical and mental quality of life (Matura et al., 2016). As the disease progresses, so do the symptoms, leading to an increased need for symptom monitoring and management by the patient and the healthcare team. The Pulmonary Arterial Hypertension Center of Comprehensive Care is an accredited facility that serves approximately 400 PAH patients residing in the gulf south region. Evidence supports a multidisciplinary, multi-pronged, comprehensive care model approach to PAH patients\u27 care as they transition through various settings. This quality improvement project introduces two telehealth interventions to address the critical care needs of this population. The first intervention was a provider-led postdischarge follow-up virtual visit that occurred one week after hospitalization. The second was scheduled nurse-led telephone calls beginning after hospital discharge. These interventions were designed to reduce hospital readmissions for this population, encourage self-care management, and remove barriers to quality healthcare by combining technology with best practice healthcare

Towards end-to-end security in internet of things based healthcare

Healthcare IoT systems are distinguished in that they are designed to serve human beings, which primarily raises the requirements of security, privacy, and reliability. Such systems have to provide real-time notifications and responses concerning the status of patients. Physicians, patients, and other caregivers demand a reliable system in which the results are accurate and timely, and the service is reliable and secure. To guarantee these requirements, the smart components in the system require a secure and efficient end-to-end communication method between the end-points (e.g., patients, caregivers, and medical sensors) of a healthcare IoT system. The main challenge faced by the existing security solutions is a lack of secure end-to-end communication. This thesis addresses this challenge by presenting a novel end-to-end security solution enabling end-points to securely and efficiently communicate with each other. The proposed solution meets the security requirements of a wide range of healthcare IoT systems while minimizing the overall hardware overhead of end-to-end communication. End-to-end communication is enabled by the holistic integration of the following contributions. The first contribution is the implementation of two architectures for remote monitoring of bio-signals. The first architecture is based on a low power IEEE 802.15.4 protocol known as ZigBee. It consists of a set of sensor nodes to read data from various medical sensors, process the data, and send them wirelessly over ZigBee to a server node. The second architecture implements on an IP-based wireless sensor network, using IEEE 802.11 Wireless Local Area Network (WLAN). The system consists of a IEEE 802.11 based sensor module to access bio-signals from patients and send them over to a remote server. In both architectures, the server node collects the health data from several client nodes and updates a remote database. The remote webserver accesses the database and updates the webpage in real-time, which can be accessed remotely. The second contribution is a novel secure mutual authentication scheme for Radio Frequency Identification (RFID) implant systems. The proposed scheme relies on the elliptic curve cryptography and the D-Quark lightweight hash design. The scheme consists of three main phases: (1) reader authentication and verification, (2) tag identification, and (3) tag verification. We show that among the existing public-key crypto-systems, elliptic curve is the optimal choice due to its small key size as well as its efficiency in computations. The D-Quark lightweight hash design has been tailored for resource-constrained devices. The third contribution is proposing a low-latency and secure cryptographic keys generation approach based on Electrocardiogram (ECG) features. This is performed by taking advantage of the uniqueness and randomness properties of ECG's main features comprising of PR, RR, PP, QT, and ST intervals. This approach achieves low latency due to its reliance on reference-free ECG's main features that can be acquired in a short time. The approach is called Several ECG Features (SEF)-based cryptographic key generation. The fourth contribution is devising a novel secure and efficient end-to-end security scheme for mobility enabled healthcare IoT. The proposed scheme consists of: (1) a secure and efficient end-user authentication and authorization architecture based on the certificate based Datagram Transport Layer Security (DTLS) handshake protocol, (2) a secure end-to-end communication method based on DTLS session resumption, and (3) support for robust mobility based on interconnected smart gateways in the fog layer. Finally, the fifth and the last contribution is the analysis of the performance of the state-of-the-art end-to-end security solutions in healthcare IoT systems including our end-to-end security solution. In this regard, we first identify and present the essential requirements of robust security solutions for healthcare IoT systems. We then analyze the performance of the state-of-the-art end-to-end security solutions (including our scheme) by developing a prototype healthcare IoT system