Current Issue : October - December Volume : 2017 Issue Number : 4 Articles : 5 Articles
Background: Hypertension is a major risk factor for cardiovascular disease, and its control rate has remained low\nworldwide. Studies have found that telemonitoring blood pressure (BP) helped control hypertension in randomized\ncontrolled trials. However, little is known about its effect in a structured primary care model in which primary care\nphysicians (PCPs) are partnering with cardiology specialists in electronic healthcare data sharing and medical\ninterventions. This study aims to identify the effects of a coordinated PCP-cardiologist model that applies telemedicine\ntools to facilitate community hypertension control in China.\nMethods/design: Patients with hypertension receiving care at four community healthcare centers that are academically\naffiliated to Shanghai Chest Hospital, Shanghai JiaoTong University are eligible if they have had uncontrolled BP in the\nprevious 3 months and access to mobile Internet. Study subjects are randomly assigned to three interventional groups:\n(1) usual care; (2) home-based BP telemonitor with embedded Global System for Mobile Communications (GSM)\nmodule and unlimited data plan, an app to access personal healthcare record and receive personalized lifestyle coaching\ncontents, and proficiency training of their use; or (3) this plus coordinated PCP-cardiologist care in which PCPs and\ncardiologists share data via a secure CareLinker website to determine interventional approaches. The primary\noutcome is mean change in systolic blood pressure over a 12-month period. Secondary outcomes are changes of\ndiastolic blood pressure, HbA1C, blood lipids, and medication adherence measured by the eight-item Morisky\nMedication Adherence Scale.\nDiscussion: This study will determine whether a coordinated PCP-Cardiologist Telemedicine Model that\nincorporates the latest telemedicine technologies will improve hypertension care. Success of the model would\nhelp streamline the present community healthcare processes and impact a greater number of patients with\nuncontrolled hypertension....
This study aimed to propose a pure web-based solution to serve users to access large-scale 3D medical volume anywhere with\ngood user experience and complete details. A novel solution of the Master-Slave interaction mode was proposed, which absorbed\nadvantages of remote volume rendering and surface rendering. On server side, we designed a message-responding mechanism to\nlisten to interactive requests from clients (Slave model) and to guide Master volume rendering. On client side, we used HTML5 to\nnormalize user-interactive behaviors on Slave model and enhance the accuracy of behavior request and user-friendly experience.\nThe results showed that more than four independent tasks (each with a data size of 249.4 MB) could be simultaneously carried\nout with a 100-KBps client bandwidth (extreme test); the first loading time was <12 s, and the response time of each behavior\nrequest for final high quality image remained at approximately 1 s, while the peak value of bandwidth was <50-KBps. Meanwhile,\nthe FPS value for each client was �40.This solution could serve the users by rapidly accessing the application via oneURL hyperlink\nwithout special software and hardware requirement in a diversified network environment and could be easily integrated into other\ntelemedical systems seamlessly....
Background: Since clinical management of heart failure relies on weights that are self-reported by the patient,\nerrors in reporting will negatively impact the ability of health care professionals to offer timely and effective\npreventive care. Errors might often result from rounding, or more generally from individual preferences for numbers\nending in certain digits, such as 0 or 5. We apply fraud detection methods to assess preferences for numbers\nending in these digits in order to inform medical decision making.\nMethods: The Telemonitoring to Improve Heart Failure Outcomes trial tested an approach to telemonitoring that\nused existing technology; intervention patients (n = 826) were asked to measure their weight daily using a digital\nscale and to relay measurements using their telephone keypads. First, we estimated the number of weights subject\nto end-digit preference by dividing the weights by five and comparing the resultant distribution with the uniform\ndistribution. Then, we assessed the characteristics of patients reporting an excess number of weights ending\nin 0 or 5, adjusting for chance reporting of these values.\nResults: Of the 114,867 weight readings reported during the trial, 18.6% were affected by end-digit preference, and\nthe likelihood of these errors occurring increased with the number of days that had elapsed since trial enrolment\n(odds ratio per day: 1.002, p < 0.001). At least 105 patients demonstrated end-digit preference (14.9% of those who\nsubmitted data); although statistical significance was limited, a pattern emerged that, compared with other patients,\nthey tended to be younger, male, high school graduates and on more medications. Patients with end-digit\npreference reported greater variability in weight, and they generated an average 2.9 alerts to the telemonitoring\nsystem over the six-month trial period (95% CI, 2.3 to 3.5), compared with 2.3 for other patients (95% CI, 2.2 to 2.5).\nConclusions: As well as overshadowing clinically meaningful changes in weight, end-digit preference can lead to\nfalse alerts to telemonitoring systems, which may be associated with unnecessary treatment and alert fatigue. In\nthis trial, end-digit preference was common and became increasingly so over time. By applying fraud detection\nmethods to electronic medical data, it is possible to produce clinically significant information that can inform the\ndesign of initiatives to improve the accuracy of reporting....
An estimated 15 million babies are born prematurely every year worldwide, and suffer from\ndisabilities. Appropriate care of these pre-term babies immediately after birth through telemedicine\nmonitoring is vital. However, problems associated with a limited bandwidth and network overload\ndue to the excessive size of the electromyography (EMG) signal impede the practical application of\nsuch medical information systems. Therefore, this research proposes an EMG uterine monitoring\ntransmission solution (EUMTS), a lossless efficient real-time EMG transmission solution that solves\nsuch problems through efficient EMG data lossless compression. EMG data samples obtained from\nthe Physionet PhysioBank database were used. Solution performance comparisons were conducted\nusing Lempel-ZivWelch (LZW) and Huffman methods, in addition to related researches. The LZW\nand Huffman methods showed CRs of 1.87 and 1.90, respectively, compared to 3.61 for the proposed\nalgorithm. This was relatively high compared to related researches, even when considering that\nthose researches were lossy whereas the proposed research was lossless. The results also showed that\nthe proposed algorithm contributes to a reduction in battery consumption by reducing the wake-up\ntime by 1470.6 ms. Therefore, EUMTS will contribute to providing an efficient wireless transmission\nenvironment for the prediction of pre-term delivery, enabling immediate interventions by medical\nprofessionals. Another novel point of EUMTS is that it is a lossless algorithm, which will prevent\nany misjudgement by clinicians because the data will not be distorted. Pre-term babies may receive\npoint-of-care immediately after birth, preventing exposure to the development of disabilities....
Background: We modified and reconstructed a high image quality portable non-mydriatic fundus camera and\ncompared it with the tabletop fundus camera to evaluate the efficacy of the new camera in detecting retinal diseases.\nMethods: We designed and built a novel portable handheld fundus camera with telemedicine system. The image\nquality of fundus cameras was compared to that of existing commercial tabletop cameras by taking photographs\nof 364 eyes from the 254 patients. In all 800 fundus images taken by two camera types, 400 images per camera,\nwere graded with the four image clarity classifications.\nResults: Using the portable fundus camera, 63% (252/400) images were graded as excellent overall quality, 20.5%\n(82/400) were good, 11.75% (47/400) were fair, and 4.75% (19/400) were inadequate. Using the tabletop fundus\ncamera, 70.75% (283/400) images were graded as excellent overall quality, 20.4% (51/400) were good, 13.25% (53/400)\nwere fair, and 3.25% (13/400) were inadequate. Common retinal diseases were easily identified from fundus\nimages obtained from the portable fundus camera.\nConclusion: The new type of non-mydriatic portable fundus camera was qualified to have professional quality of\nfundus images. The revolutionary screening camera provides a foundational platform which can potentially improve\nthe accessibility of retinal screening programmes....
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