Technological development expands the computation process of smart devices that adopt the telecare medical information system (TMIS) to fulfill the demands of the healthcare organization. It provides ...better medical identification to claim the features namely trustworthy, efficient, and resourceful. Moreover, the telecare services automate the remote healthcare monitoring process to ease professional workloads. Importantly, it is conceived to be more timesaving, economical, and easy healthcare access. Cloud-Based Medical Healthcare (CBMH) system is a standard platform that gives its support to the patients for emergency treatment from the medical experts over Internet communication. Since the medical records are very sensitive, security protection is much necessitated. In addition, patient anonymity should be well preserved. In 2016, Chiou et al. proposed a mutual authentication protocol for the Telecare Medical Information System (TMIS) using Cloud Environment (CE). They claim that their protocol satisfies patient anonymity. However, this paper proves that the Chiou et al. scheme is not only completely insecure against the patient anonymity, health-report revelation, health-report forgery, report confidentiality, and non-repudiation but also fails to validate the service access against verifiability, undeniability and unforgeability. In order to provide better mutual authenticity, this paper suggests the framework of smart service authentication to cross-examine the common secret session key among the communication entities. In order to examine the security properties, formal and informal verification was carried out. Lastly, to prove the security and performance efficiency of a system, the proposed SSA framework was implemented using FPGA and Moteiv TMote Sky-Mote. A proposed smart service authentication (SSA) framework is presented to ensure better data security between the patients and the physicians. The formal and informal security analysis proves the significance of the SSA framework model to withstand the security attacks such as health-report forgery, health-report revelation, server-spoofing etc. As a result, it is claimed that it can be well suited for TMIS.
Background
Telemonitoring and telerehabilitation can support home-based pulmonary rehabilitation (PR) and benefit patients with lung diseases or COVID-19. This study aimed to (1) identify which ...telemonitoring and telerehabilitation interventions (e.g. videoconferencing) are used to provide telehealth care for people with chronic respiratory conditions or COVID-19, and (2) provide an overview of the effects of telemonitoring and telerehabilitation on exercise capacity, physical activity, health-related QoL (HRQoL), and healthcare use in patients with lung diseases or COVID-19.
Methods
A search was performed in the electronic databases of Ovid MEDLINE, EMBASE, and Cinahl through 15 June 2021. Subject heading and keywords were used to reflect the concepts of telemonitoring, telerehabilitation, chronic lung diseases, and COVID-19. Studies that explored the effect of a telerehabilitation and/or telemonitoring intervention, in patients with a chronic lung disease such as asthma, chronic obstructive pulmonary diseases (COPD), or COVID-19, and reported the effect of the intervention in one or more of our outcomes of interest were included. Excluding criteria included evaluation of new technological components, teleconsultation or one-time patient assessment.
Results
This scoping review included 44 publications reporting the effect of telemonitoring (25 studies), telerehabilitation (8 studies) or both (11 studies) on patients with COPD (35 studies), asthma (5 studies), COPD and asthma (1 study), and COVID-19 (2 studies). Patients who received telemonitoring and/or telerehabilitation had improvements in exercise capacity in 9 out of 11 (82%) articles, better HRQoL in 21 out of 25 (84%), and fewer health care use in 3 out of 3 (100%) articles compared to pre-intervention. Compared to controls, no statistically significant differences were found in the intervention groups’ exercise capacity in 5 out 6 (83%) articles, physical activity in 3 out of 3 (100%) articles, HRQoL in 21 out of 25 (84%) articles, and healthcare use in 15 out of 20 (75%) articles. The main limitation of the study was the high variability between the characteristics of the studies, such as the number and age of the patients, the outcome measures, the duration of the intervention, the technological components involved, and the additional elements included in the interventions that may influence the generalization of the results.
Conclusion
Telemonitoring and telerehabilitation interventions had a positive effect on patient outcomes and appeared to be as effective as standard care. Therefore, they are promising alternatives to support remote home-based rehabilitation in patients with chronic lung diseases or COVID-19.
Background: The idea of product usability has been discussed in several research areas including product research and development. Usability, in telecare monitoring systems, determines how much the ...system is effective and efficient for the telecare users. Usability has been considered an important factor in the acceptance of telecare monitoring systems by individuals who encounter challenges in the use of such systems and who possess a limited knowledge of their use.
Objectives: The purpose of this study is to explore the relevant usability issues and identify possible solutions to improve the usability of telecare monitoring systems.
Method: The study is based on eight research questions and to find the answers to those research questions, a systematic literature is performed.
Results: The research findings highlight various usability issues, including the complexity of the interface, difficulty in reading the text, and insufficient provision of instructions. These studies have also suggested solutions to enhance the usability of systems, including development of the technical skills of users, explanations of usability evaluation techniques for telecare monitoring systems, and engaging the appropriate users during the development of telecare monitoring systems.
Implications for rehabilitation
Successful implementation of telecare monitoring systems can increase the chances of acceptance of telecare monitoring systems by the users.
Implementing an efficient and effective system will make telecare users more independent at their homes.
The development of usable telecare monitoring systems can significantly contribute to a basis for clinical and home-based implementation of the telehealth technology to promote remote monitoring for elderly and people with disabilities.
Considering the usability issues and solutions identified in this study, it will go a long way towards aiding subsequent researchers and developers in the implementation of more usable and valid telecare monitoring systems.
Low detection and nonadherence are major problems in current management approaches for patients with suspected atrial fibrillation (AF). Mobile health devices may enable earlier AF detection and ...improved AF management.
This study sought to investigate the effectiveness of AF screening in a large population-based cohort using smart device–based photoplethysmography (PPG) technology, combined with a clinical care AF management pathway using a mobile health approach.
AF screening was performed with smart devices using PPG technology, which were made available for the population ≥18 years of age across China. Monitoring for at least 14 days with a wristband (Honor Band 4) or wristwatch (Huawei Watch GT, Honor Watch, Huawei Technologies Co., Ltd., Shenzhen, China) was allowed. The patients with “possible AF” episodes using the PPG algorithm were further confirmed by health providers among the MAFA (mobile AF app) Telecare center and network hospitals, with clinical evaluation, electrocardiogram, or 24-h Holter monitoring.
There were 246,541 individuals who downloaded the PPG screening app, and 187,912 individuals used smart devices to monitor their pulse rhythm between October 26, 2018, and May 20, 2019. Among those with PPG monitoring (mean age 35 years, 86.7% male), 424 (of 187,912, 0.23%) (mean age 54 years, 87.0% male) received a “suspected AF” notification. Of those effectively followed up, 227 individuals (of 262, 87.0%) were confirmed as having AF, with the positive predictive value of PPG signals being 91.6% (95% confidential interval CI: 91.5% to 91.8%). Both suspected AF and identified AF markedly increased with age (p for trend <0.001), and individuals in Northeast China had the highest proportion of detected AF of 0.28% (95% CI: 0.20% to 0.39%). Of the individuals with identified AF, 216 (of 227, 95.1%) subsequently entered a program of integrated AF management using a mobile AF application; approximately 80% of high-risk patients were successfully anticoagulated.
Based on the present study, continuous home monitoring with smart device–based PPG technology could be a feasible approach for AF screening. This would help efforts at screening and detection of AF, as well as early interventions to reduce stroke and other AF-related complications. (Mobile Health mHealth Technology for Improved Screening, Patient Involvement and Optimizing Integrated Care in Atrial Fibrillation MAFA II; ChiCTR-OOC-17014138)
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In the recent COVID-19 situation, Telecare Medical Information System (TMIS) is attracting attention. TMIS is one of the technologies used in Wireless Body Area Network (WBAN) and can provide ...patients with a variety of remote healthcare services. In TMIS environments, sensitive data of patients are communicated via an open channel. An adversary may attempt various security attacks including impersonation, replay, and forgery attacks. Therefore, numberous authentication schemes have been suggested to provide secure communication for TMIS. Sahoo et al. proposed a mutual authentication scheme based on biometrics and Elliptic Curve Cryptography (ECC) in 2020. However, we find out that Sahoo et al. 's scheme cannot resist insider and privileged insider attacks and cannot guarantee patient anonymity. In this paper, we propose a secure ECC-based three-factor mutual authentication protocol that guarantees the privacy of patients for TMIS. We conduct informal security analysis to prove that our protocol is secure from various security attacks. In addition, we perform formal security analyses using the Automated Validation of Internet Security Protocols and Applications (AVISPA), Burrows-Abadi-Needham (BAN) logic, and the Real-Or-Random (ROR) model. Furthermore, we assess our protocol's performance and compare it to other protocols. As a result, our protocol has lower communication costs, and better security features compared to related existing protocols. Therefore, our protocol is more appropriate for TMIS environments than other related protocols.
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