Connected Health And Telemedicine

Electrooculography-based Human-Computer Interaction (EOG-HCI) is an emerging field. Research in this domain aims to capture eye movement patterns by measuring the corneal-retinal potential difference. This enables translating eye movements into commands, facilitating human-computer interaction through eye movements. This paper reviews articles published from 2002 to 2022 in the EOG-HCI domain, aiming to provide a comprehensive analysis of the current developments and challenges in this field. It includes a detailed and systematic analysis of EOG signal electrode arrangement, hardware design for EOG signal acquisition, commonly used features, and algorithms. Representative studies in each section are presented to help readers quickly grasp the common technologies in this field. Furthermore, the paper emphasizes the analysis of interaction design within the EOG-HCI domain, categorizing different interaction task types and modalities to provide insights into prevalent interaction research. The focus of current research in the field is revealed by examining commonly used evaluation metrics. Lastly, a user-centered EOG-HCI research model is proposed to visually present the current research status in the EOG-HCI field from the perspective of users. Additionally, we highlight the challenges and opportunities in this field.

The measurement and monitoring of continuous arterial blood pressure (BP) have undergone significant evolution over the past 170 years, transitioning from ancient invasive approaches, like kymograph, to modern non-invasive and unobtrusive technologies such as tonoarteriography (TAG). This progressive shift has revolutionized the way we track BP, providing safer, more accurate, and convenient methods for monitoring BP. This paper aims to provide some historical perspectives on the development of continuous BP technology, highlight key milestones that have shaped the field, discuss the state-of-the-art two-dimensional TAG imaging, and address challenges for future unobtrusive BP measurements. In addition to presenting a concise review of the progression of continuous BP measurement technologies, this article also emphasizes the importance of adopting more precise, convenient and affordable approaches for personalized BP monitoring at home and patient care optimizations at hospitals, thereby empowering healthcare professionals to enhance pervasive hypertension management anywhere.

During the past three years, tremendous efforts have been made to tackle the Coronavirus Disease 2019 (COVID-19) crisis, including centralized quarantine, compulsory testing, and sweeping lockdowns. The measures have taken effect, but have caused a huge burden on healthcare systems and significant disruption to global economies on an unprecedented scale. Recently, some countries and regions have observed signs of the pandemic resurgence. To better handle the resurgence in the post-COVID era and future pandemics, an immediate revolution of the precise and rapid responding system capable of early detection is needed. Based on a comprehensive review, this article summarizes the enabling wearable devices in physiological monitoring and biomolecular diagnosis, highlights their potential contributions to the detection and management of COVID-19, as well as its long-term effects, and suggests a wearable sensing-based system to avoid future pandemics. Wearable devices, in conjunction with mobile health (mHealth) technologies, provide a novel way to track and monitor diseases through continuous physiological, physical, and biomolecular sensing. Augmented by artificial intelligence (AI), especially the emerging Generative Pre-trained Transformer (GPT) algorithms, patients could potentially be identified before they become symptomatic. By combining contact tracing and effective quarantine, it is possible to arrest the spread of the disease and control its emergence at an early stage. Furthermore, with minor refinements, the proposed response system holds the potential for extended use beyond COVID-19, particularly in addressing cardiovascular diseases (CVDs) during both outbreaks and non-pandemic scenarios. By implementing this groundbreaking approach, there exist valuable prospects to transform the current healthcare paradigm and drive significant advancements in disease prevention, detection, and management.

Aim: Financial incentives improve response to electronic health surveys, yet little is known about how unconditional incentives (guaranteed regardless of survey completion), conditional incentives, and various combinations of incentives influence response rates. We compared electronic health survey completion with two different financial incentive structures. Methods: We invited women aged 30-64 years enrolled in a U.S. healthcare system and overdue for Pap screening to complete a web-based survey after receiving a mailed human papillomavirus (HPV) self-sampling kit in a pragmatic trial. HPV kit returners (n = 272) and non-returners (n = 1,083) were allocated to one of two different incentive structures: (1) Unconditional: $5 pre-incentive only (n = 653); (2) Combined: $2 pre-incentive plus $10 post-incentive conditional on completion (n = 702). Chi-square tests evaluated whether survey completion differed by incentive structure within kit return groups or was modified by kit return status. For each incentive-by-kit status group, the cost-per-survey response was calculated as: ([number invited*pre-incentive amount] + [number responses*post-incentive amount]) / number responses. Results: Overall, survey response was higher in kit returners vs. kit non-returners (42.6% vs. 11.0%, P < 0.01), and survey response was higher in the combined (20.1%) vs. unconditional (14.4%) incentive group (P = 0.01). Kit return status did not modify the association between incentive type and survey response (P = 0.52). Among respondents, time to survey completion did not differ by incentive type among either kit returners or non-returners. Among returners, the cost-per-survey response was similar between groups ($13.57 unconditional; $14.15 combined); among non-returners, the cost was greater in the unconditional ($57.78) versus the combined ($25.22) group. Conclusion: A combined incentive can be cost-effective for increasing survey response in health services research, particularly in hard-to-reach populations.

Telehealth has seen rapid adoption in the past three years as a direct result of the COVID-19 pandemic. Conventional methods for the measurement of vital signs are neither optimized for remote care nor highly scalable. Blood pressure is a critical vital parameter that currently cannot be measured remotely. Cameras are versatile and capable sensors that can be repurposed to measure vital signs. In this article, we review the use of cameras for remote photoplethysmography and assessment of blood pressure. We discuss the principles behind this technology and the current evidence for blood pressure measurement. We also explore future applications and potential challenges to provide a roadmap for researchers, clinicians, and regulators considering this new technology.

Aim: The aims of this study were to (i) understand what adolescents (and their parents) identify as positive and negative experiences with technology for engaging in physical activity (PA) when living with type 1 diabetes (T1D) and (ii) identify possible future design considerations for supporting or enabling technologies for this population. Methods: Nine online collaborative workshops (n = 25 people) were held over a month with participants who were either adolescents attending with (n = 22) or without (n = 3, aged 16 and over) parents. Each workshop involved (1) a training activity, (2) a design task involving describing a good day vs. a bad day, and (3) a design task asking people to consider future design changes for technology to support them in engaging with physical activity. Results: The following key themes emerged from the first design task: (1) Wearable factors; (2) Social acceptance & identity; (3) Negative emotions; (4) Glycaemic stability offers positive emotions and PA Enjoyment; and (5) Presence, preparation & prevention. The second design task identified the following additional key themes: (6) Improve attachment experiences; (7) Connected devices reduce user burden; (8) Improve accuracy; (9) Personalisation of devices; (10) Funding and policy changes – health equity. Conclusion: Technology can reduce the burden and improve PA support, but there are still gaps in how these technologies can be better designed to consider the psychosocial and emotional factors of both adolescents and their parents as co-users.

There is a rising problem of multiple long-term conditions (“multimorbidity”) as the global population ages. Old age is the biggest risk factor for having one or more chronic conditions. Unfortunately, current care processes can be fragmented, with most focusing on individual diseases. This can lead to unintended consequences for patients, particularly if they are admitted onto an inappropriate care pathway, along with subsequent economic downsides. When people with multiple long-term conditions deteriorate, detection of illness may be delayed due to a range of non-specific symptoms being displayed. At present, there is limited research on detecting deterioration within community settings, thereby forming the basis of earlier interventions. A general measure, such as how active an individual is, might allow initial identification of decline and trigger a more targeted approach to assess the underlying reason for deterioration. Restricted activity seems to manifest earlier than the routinely used single condition clinical markers, and has been identified both in the last year of life and during periods of illness. Changes in activity could facilitate the identification of illness, leveraging technology to determine any decline. However, there is still no universally agreed definition of what constitutes a change in activity and, therefore, no accepted method of measuring it. This paper reviews the potential for a connected health approach to monitoring older adults with multimorbidity, using restricted activity as a general measure of health decline.

Hypertension is a major cause of cardiovascular disease worldwide and a major cause of morbidity and mortality in patients with chronic kidney disease (CKD). The Systolic Blood pressure Intervention Trial (SPRINT) demonstrated that blood pressure (BP) measurement techniques may have an impact on the achievement of outcomes. Home BP monitoring (HBPM) has several advantages over office BP recordings, including avoidance of white-coat reaction, ability to diagnose white-coat and masked hypertension, detection of BP variability, and better ability to predict cardiovascular morbidity and mortality, all of which commonly occur in CKD. The addition of telemonitoring and management support to HBPM allows remote monitoring, especially when close contact is difficult (e.g., patients in remote/rural areas, pandemic, natural disaster, or patients treated with home dialysis). Although there are few studies that have assessed the efficacy of home BP telemonitoring (HBPT) in patients with CKD, these studies suggest the benefits of HBPT for BP control and even limited evidence that it may improve kidney function. This review, using limited available evidence, assesses the roles of HBPT in patients with CKD, barriers to HBPT implementation in the care of patients with CKD, and discusses newer technologies that can be leveraged in the management of hypertension in patients with CKD.

Hypertension is the leading contributor to cardiovascular disease (CVD)-related deaths globally, with Africa being one of the World Health Organization regions with the highest prevalence of elevated blood pressure (BP). In sub-Saharan Africa (SSA), awareness, treatment, and control levels of hypertension remain low in both men and women and in different settings, including rural and urban areas. Important barriers to the management of hypertension in SSA are within health systems, usually overburdened by communicable and non-communicable diseases, acute medical conditions, and child and maternal healthcare. Health system-related challenges include the availability and cost of essential medicines and healthcare workforce constraints. At the patient level, individual barriers such as sociodemographic, economic, and psychosocial factors contribute significantly to the poor control of hypertension. Telemedicine presents a promising approach to improve the delivery of optimal care for individuals living with hypertension by serving as a connection between healthcare providers and patients. This may enhance access to isolated people living with hypertension, such as in rural areas. However, there is a concern that telemedicine may exacerbate some of the barriers to the management of hypertension in disadvantaged groups, such as those with limited access to digital technology, low education and literacy levels, and the ageing population. Therefore, the objective of this review is to summarize the current state of telemedicine use in the management of hypertension in SSA and discuss the challenges and opportunities to provide cost-effective, equitable, and sustainable access to digital health technology for people living with hypertension in SSA.

How to cite this article: Bhandari B, Neupane D, Thapa P, Pradhan PMS. Use of mHealth for management of hypertension in low and middle-income countries: opportunities and challenges. Conn Health 2023;2:1-8. https://dx. Abstract Despite being the leading cause of global mortality, the hypertension control rate is astonishingly low, particularly in low-and middle-income countries. There is evidence that the mHealth approach is a potential platform for delivering interventions for hypertension management. Our recent study from Nepal also provided strong evidence for reducing blood pressure, improving control rate, and medication adherence. The objective of this paper is to document the real-world experience of designing and implementing a mHealth project in Nepal and relates them with the evidence from other similar Low-and Middle-Income Country (LMIC) settings. We learned that mHealth provides a unique opportunity to bridge the gap between providers and patients, send health education and reminder messages, secure patients' privacy, and make data management easier. We also encountered technological and financial barriers, unclear mHealth policy and guidelines, and low literacy levels, including digital literacy. As many of them are addressable, integrating mHealth provides a promising approach to hypertension management.

In just over a half-century since the initiation of telemedicine, technological developments have created multiple options to shape how patients can access healthcare and interact with healthcare providers to better prevent and manage hypertension. In several high-income countries, patients are connecting to their healthcare providers online to book appointments, request prescriptions, see test results and engage in pro-active health management. Mounting evidence suggests that telemedicine and mobile health (mHealth) services can yield greater reductions in blood pressure when compared with usual care while also offering greater reach, efficiency, and potential cost-saving. A deeper examination of implementing such systems at scale in high-income countries shows varying approaches and levels of success. While research investigating the benefits of technology for blood pressure control in low- and middle-income countries is growing, in regions such as sub-Saharan Africa, economic and digital divides present major challenges to scaling such technology. Substantial national investments in infrastructure and skills development are needed alongside consultation with multiple stakeholders to ensure that technological advancements do not further drive health disparities in the region.

Aim: Guidelines recommend treating hypertension (HTN) by keeping office blood pressure (BP) within the therapeutic range (TR). However, little is known about the TR of home BP. Therefore, we aimed to find a reliable proportion of home systolic (S) BP in TR (sBPiTR) using a telehealth platform, which facilitates the access to reliable and structured home BP data. Methods: We used the data of HTN patients who participated in BP telemonitoring and counseling for 3 months. Patients had to manually enter their home BP in electronic diaries. Home SBP readings were averaged by the system itself except the very first or every first day of BP monitoring. We divided sBPiTR (110-130 mmHg) by quartiles. A weighted Cohen’s kappa coefficient was used as an estimate of inter-rater reliability between sBPiTR and office/home SBP in TR. We used a binomial logistic regression to test the predictive value of sBPiTR on target office/home SBP achievement. Results: In total, 123 patients were included (median age 54 years; 102 males) with a median office SBP of 140 mmHg. By 3 months, it decreased to 130 mmHg (P < 0.001), with 60% of patients with target office BP and 70% in the upper sBPiTR quartiles. There was a slight agreement between office SBP in TR and sBPiTR of ≥ 50% (k = 0.19, P < 0.035) and fair agreement when countered against home SBP in TR (k = 0.32-0.65, P < 0.0001). Patients with sBPiTR of ≥ 50% were more likely to fall within the office and home SBP TR after adjustment for baseline covariates. Conclusion: The threshold of 50% of home SBP measurements within 110-130 mmHg has a slight agreement with office BP control and a fair agreement with home BP control. This variable may serve as a predictor for the achievement of target SBP both in and out of office. Larger studies are needed to confirm these preliminary results.

Obtaining data is challenging for researchers, especially when it comes to medical data. Moreover, using medical data as there are concerns about privacy and confidentiality issues requires specific considerations. Generative models aim to learn data distribution via various statistical learning approaches. Among generative models, a machine learning-based approach named Generative Adversarial Networks (GANs) has proved their potential in the implicit density estimation of high dimensional data. Therefore, we suggest an approach that each healthcare organization, especially hospitals, could create and share their own GAN model, entitled Hospital-Based GANs (H-GANs), instead of sharing raw data of patients.

Hypertension is the leading cause of cardiovascular disease worldwide. Telemedicine may support doctors and health care professionals to raise awareness, increase detection, and improve the management of hypertension, by enhancing the connection with their patients. Given the growing popularity of telemedicine, the objective of the present review paper is to present the typical applications of telemedicine in hypertension management and available recommendations for use and summarize the evidence of their clinical efficacy before and during COVID-19 and the future trends and perspectives. Blood pressure telemonitoring (BPT), which enables remote transmission of BP and additional information on a patient’s health status from different settings to a healthcare facility, is the most common application of telemedicine for hypertension management. BPT is an integral component of a complex and multifaceted intervention, which includes video consultation, education on lifestyle and risk factors, antihypertensive medication review and management, and multidisciplinary team care. Several randomized controlled studies documented larger BP reduction and enhanced BP control with telemedicine compared to usual care. Telemedicine also helps optimize antihypertensive medications, improve treatment adherence, reduce office visits and resort to laboratory tests, and improve quality of life. At the time of COVID-19, telemedicine has helped to maintain adequate BP control in hypertensive patients under home confinement. Consequently, telemedicine is generally recommended to ensure continuity of care for hypertensive patients with uncontrolled BP, older patients, those at high risk of developing cardiovascular diseases, those with multiple comorbidities, medically underserved people, or patients isolated due to pandemics or national emergencies. Telemedicine applications relying on smart wearables, cuffless BP monitors, multiparametric devices, ambient sensors, and tools integrated with machine learning algorithms are particularly promising for telemedicine’s future development and diffusion since they may provide continuous surveillance of patients and remarkable support decision tools for doctors.

Aim: Digital health for hypertension management holds potential for improving the quality of care but requires long-term patient engagement to track health data. We explored patient and hypertension specialist perceptions of clinical utility for data tracking including standardized patient-reported outcome measures (PROMs), home blood pressure (BP) measurement, and other health metrics. Methods: Participants reviewed general health status, patient satisfaction, and hypertension-specific PROMs. Semi-structured focus groups (n = 15) with nine patients with hypertension and six hypertension specialists were audio-recorded and thematically analyzed. Results: Key themes identified from patients included: (1) comfort and appreciation of home BP monitoring but only during important periods of hypertension care; (2) preference for tracking new symptoms and medication side effects; (3) patients perceived tracking other health measures including general PROMs, diet and exercise as less relevant to their care; and (4) visually represented BP trends evaluating associations with changes in other health parameters were perceived as useful. Key themes identified by hypertension specialists included: (1) concerns about patient digital literacy; (2) utilizing visual representations of long-term BP data trends for patient empowerment; and (3) unclear relevance of tracking medication adverse effects, PROMs, and other non-BP health metrics. Conclusion: Patients and hypertension specialists had similar perspectives for most aspects of data monitoring but differed in preference for a few aspects that were germane to patients, including monitoring medication adverse effects and symptoms. Including views on data tracking from both patients and providers are essential for designing digital tools to optimize hypertension management.

The COVID-19 pandemic created increased interest in monitoring patients at home to allow timely recognition of health deteriorations. Hospital care is particularly demanding in these patients because of the necessity for isolation to avoid further spread of the disease. Therefore, home care is a preferred treatment setting for these patients. This is, to our knowledge, the first report indicating the potential of an affordable, contactless, and unobtrusive ambient sensor system for the detection of signs of health deterioration in a patient with COVID-19 by a caregiver from a distance. Prospective data acquisition and correlation of the data with clinical events were obtained from an 81-year-old senior with COVID-19 before and, in particular, over a period of 10 days prior to hospitalization. Clinical signs included weakness, increased respiration rate, sleep disturbances, and confusion. The visualization of a combination of this information on a dedicated dashboard allowed the caregiver to recognize a serious health deterioration that required a lifesaving hospitalization. The potential of such ambient sensor systems to detect signs of serious health deterioration in patients with COVID-19 opens new opportunities for use in asymptomatic or oligosymptomatic patients who live alone and are sent back to their homes for isolation in quarantine after diagnosis.

“Digital hypertension” is a new information and communication technology (ICT)-based research field of digital healthcare that adds significant value to the management of hypertension by integrating multidimensional and time-series data. It includes the study of pathogenesis and predictive, individualized, and preemptive treatments, and its clinical outcomes can be introduced in telemedicine. The ICT in digital hypertension includes the research and development of blood pressure (BP) monitoring, e.g., wearable, cuff-less BP monitoring, a platform for digital transformation and transmission systems, and artificial intelligence. A recent clinical trial demonstrated the significant BP-lowering effect of digital therapeutics that facilitate lifestyle modification at the individual level via the patient’s smartphone. One of the goals of digital hypertension is personalized anticipation medicine that identifies the timing, place, and behavior that may trigger the onset of a cardiovascular event. This narrative review aims to address and discuss the cutting-edge information on the technology and concept of “digital hypertension”.

Ambulatory blood pressure measurement (ABPM) is the gold-standard method for blood pressure assessment. However, it is markedly underutilized, in part because legacy software provided with ABPM devices is archaic and inefficient. Herein, we illustrate an example of a recently developed cloud-based ABPM platform. Such a platform offers several distinct advantages: (1) the ability to guide users through the testing process; (2) synchronizing inputs of the technician, patient, physician, and administrative assistant so that testing can be successful and efficient; (3) providing guideline-concordant study interpretations that can be e-signed, reducing physician interpretation times; (4) enabling central expert oversight and peripheral deployment of testing, thereby increasing accessibility of quality testing; and (5) facilitating integration into electronic medical records, improving dissemination of results. It is envisioned that increased use of cloud-based ABPM platforms will lead to the expansion of quality ABPM testing, thus improving the care of patients with known or suspected hypertension.

During the COVID-19 pandemic, telemedicine has emerged worldwide as an indispensable resource to improve the surveillance of patients, curb the spread of disease, facilitate timely identification and management of ill people, but, most importantly, guarantee the continuity of care of frail patients with multiple chronic diseases. Although during COVID-19 telemedicine has thrived, and its adoption has moved forward in many countries, important gaps still remain. Major issues to be addressed to enable large scale implementation of telemedicine include: (1) establishing adequate policies to legislate telemedicine, license healthcare operators, protect patients’ privacy, and implement reimbursement plans; (2) creating and disseminating practical guidelines for the routine clinical use of telemedicine in different contexts; (3) increasing in the level of integration of telemedicine with traditional healthcare services; (4) improving healthcare professionals’ and patients’ awareness of and willingness to use telemedicine; and (5) overcoming inequalities among countries and population subgroups due to technological, infrastructural, and economic barriers. If all these requirements are met in the near future, remote management of patients will become an indispensable resource for the healthcare systems worldwide and will ultimately improve the management of patients and the quality of care.