Empowering patients in self-management of parkinson's disease through cooperative ICT systems

The objective of this chapter is to demonstrate the technical feasibility and medical effectiveness of personalised services and care programmes for Parkinson's disease, based on the combination of mHealth applications, cooperative ICTs, cloud technologies and wearable integrated devices, which empower patients to manage their health and disease in cooperation with their formal and informal caregivers, and with professional medical staff across different care settings, such as hospital and home. The presented service revolves around the use of two wearable inertial sensors, i.e. SensFoot and SensHand, for measuring foot and hand performance in the MDS-UPDRS III motor exercises. The devices were tested in medical settings with eight patients, eight hyposmic subjects and eight healthy controls, and the results demonstrated that this approach allows quantitative metrics for objective evaluation to be measured, in order to identify pre-motor/pre-clinical diagnosis and to provide a complete service of tele-health with remote control provided by cloud technologies. © 2016, IGI Global. All rights reserved

Affective Medicine: a review of Affective Computing efforts in Medical Informatics

Background: Affective computing (AC) is concerned with emotional interactions performed with and through computers. It is defined as “computing that relates to, arises from, or deliberately influences emotions”. AC enables investigation and understanding of the relation between human emotions and health as well as application of assistive and useful technologies in the medical domain. Objectives: 1) To review the general state of the art in AC and its applications in medicine, and 2) to establish synergies between the research communities of AC and medical informatics. Methods: Aspects related to the human affective state as a determinant of the human health are discussed, coupled with an illustration of significant AC research and related literature output. Moreover, affective communication channels are described and their range of application fields is explored through illustrative examples. Results: The presented conferences, European research projects and research publications illustrate the recent increase of interest in the AC area by the medical community. Tele-home healthcare, AmI, ubiquitous monitoring, e-learning and virtual communities with emotionally expressive characters for elderly or impaired people are few areas where the potential of AC has been realized and applications have emerged. Conclusions: A number of gaps can potentially be overcome through the synergy of AC and medical informatics. The application of AC technologies parallels the advancement of the existing state of the art and the introduction of new methods. The amount of work and projects reviewed in this paper witness an ambitious and optimistic synergetic future of the affective medicine field

Business Case and Technology Analysis for 5G Low Latency Applications

A large number of new consumer and industrial applications are likely to change the classic operator's business models and provide a wide range of new markets to enter. This article analyses the most relevant 5G use cases that require ultra-low latency, from both technical and business perspectives. Low latency services pose challenging requirements to the network, and to fulfill them operators need to invest in costly changes in their network. In this sense, it is not clear whether such investments are going to be amortized with these new business models. In light of this, specific applications and requirements are described and the potential market benefits for operators are analysed. Conclusions show that operators have clear opportunities to add value and position themselves strongly with the increasing number of services to be provided by 5G.Comment: 18 pages, 5 figure

Design and implementation of a secure and user-friendly broker platform supporting the end-to-end provisioning of e-homecare services

We designed a broker platform for e-homecare services using web service technology. The broker allows efficient data communication and guarantees quality requirements such as security, availability and cost-efficiency by dynamic selection of services, minimizing user interactions and simplifying authentication through a single user sign-on. A prototype was implemented, with several e-homecare services (alarm, telemonitoring, audio diary and video-chat). It was evaluated by patients with diabetes and multiple sclerosis. The patients found that the start-up time and overhead imposed by the platform was satisfactory. Having all e-homecare services integrated into a single application, which required only one login, resulted in a high quality of experience for the patients

A Systematic Review of the Economic Evaluation of Telemedicine in Japan.

ObjectivesThere is no systematic review on economic evaluations of telemedicine in Japan, despite over 1000 trials implemented. Our systematic review aims to examine whether Japan's telemedicine is cost-saving or cost-effective, examine the methodological rigorousness of the economic evaluations, and discuss future studies needed to improve telemedicine's financial sustainability.MethodsWe searched five databases, including two Japanese databases, to find peer-reviewed articles published between January 1, 2000 and December 31, 2014 in English and Japanese that performed economic evaluations of Japan's telemedicine programs. The methodological rigorousness of the economic analyses was assessed with a well-established checklist. We calculated the benefit-to-cost ratio (BCR) when a reviewed study reported related data but did not report the BCR. All cost values were adjusted to 2014 US dollars.ResultsAmong the 17 articles identified, six studies reported on settings connecting physicians for specialist consultations, and eleven studies on settings connecting healthcare providers and patients at home. There are three cost-benefit analyses and three cost-minimization analyses. The remaining studies measured the benefit of telemedicine only, using medical expenditure saved or users' willingness-to-pay. There was substantial diversity in the methodological rigorousness. Studies on teledermatology and teleradiology indicated a favorable level of economic efficiency. Studies on telehomecare gave mixed results. One cost-benefit analysis on telehomecare indicated a low economic efficiency, partly due to public subsidy rules, e.g., a too short budget period.ConclusionsOverall, telemedicine programs in Japan were indicated to have a favorable level of economic efficiency. However, the scarcity of the economic literature indicates the need for further rigorous economic evaluation studies

Integrating digital Health services : the role of the government and the challenge of cost allocation

eHealth, mHealth and eCare services are growing in numbers at a fast pace. This is mainly driven by technology and the societal challenges of an aging and more chronically burdened population while pressure on both human and financial resources increases. Though the adoption of these digital health services is challenging and experience difficulties. This work focusses on the main barriers that cause a 'gap' in the value network. Via case research following barriers are identified: 1) low willingness to pay, 2) unbalanced cost/benefit ratios of the actors or unfair cost allocation and 3) negative impacted business models. Furthermore the several roles of the government within the value network of digital health services are discussed and reflections and guidelines for digital health service developers are foreseen

Equivalent Mid-Term Results of Open vs Endoscopic Gluteal Tendon Tear Repair Using Suture Anchors in Forty-Five Patients.

BackgroundLittle is known about the relative efficacy of open (OGR) vs endoscopic (EGR) gluteal tendon repair of gluteal tendon tears in minimizing pain and restoring function. Our aim is to compare these 2 surgical techniques and quantify their impact on clinical outcomes.MethodsAll patients undergoing gluteal tendon tear repair at our institution between 2015 and 2018 were retrospectively reviewed. Pain scores, limp, hip abduction strength, and the use of analgesics were recorded preoperatively and at last follow-up. The Hip disability and Osteoarthritis Outcome Score Junior and Harris Hip Score Section1 were obtained at last follow-up. Fatty degeneration was quantified using the Goutallier-Fuchs Classification (GFC). Statistical analysis was conducted using one-way analysis of variance and t-tests.ResultsForty-five patients (mean age 66, 87% females) met inclusion criteria. Average follow-up was 20.3 months. None of the 10 patients (22%) undergoing EGR had prior surgery. Of 35 patients (78%) undergoing OGR, 12 (27%) had prior hip replacement (75% via lateral approach). The OGRs had more patients with GFC ≥2 (50% vs 11%, P = .02) and used more anchors (P = .03). Both groups showed statistical improvement (P ≤ .01) for all outcomes measured. GFC >2 was independently associated with a worst limp and Harris Hip Score Section 1 score (P = .05). EGR had a statistically higher opioid use reduction (P < .05) than OGR. Other comparisons between EGR and OGR did not reach statistical significance.ConclusionIn this series, open vs endoscopic operative approach did not impact clinical outcomes. More complex tears were treated open and with more anchors. Fatty degeneration adversely impacted outcomes. Although further evaluation of the efficacy of EGR in complex tears is indicated, both approaches can be used successfully

Digital Orthopaedics: A Glimpse Into the Future in the Midst of a Pandemic.

BackgroundThe response to COVID-19 catalyzed the adoption and integration of digital health tools into the health care delivery model for musculoskeletal patients. The change, suspension, or relaxation of Medicare and federal guidelines enabled the rapid implementation of these technologies. The expansion of payment models for virtual care facilitated its rapid adoption. The authors aim to provide several examples of digital health solutions utilized to manage orthopedic patients during the pandemic and discuss what features of these technologies are likely to continue to provide value to patients and clinicians following its resolution.ConclusionThe widespread adoption of new technologies enabling providers to care for patients remotely has the potential to permanently change the expectations of all stakeholders about the way care is provided in orthopedics. The new era of Digital Orthopaedics will see a gradual and nondisruptive integration of technologies that support the patient's journey through the successful management of their musculoskeletal disease

Transnational comparison : A retrospective study on e-health in sparsely populated areas of the northern periphery

Peer reviewedPublisher PD