Search Results (1,495)

Most of the existing research on video watermarking schemes focus on improving the robustness of watermarking. However, in application scenarios such as judicial forensics and telemedicine, the distortion caused by watermark embedding on the original video is unacceptable. To solve this problem, this paper proposes a robust reversible watermarking (RRW)scheme based on multi-layer embedding in the video compression domain. Firstly, the watermarking data are divided into several sub-secrets by using Shamir’s (t, n)-threshold secret sharing. After that, the chroma sub-block with more complex texture information is filtered out in the I-frame of each group of pictures (GOP), and the sub-secret is embedded in that frame by modifying the discrete cosine transform (DCT) coefficients within the sub-block. Finally, the auxiliary information required to recover the coefficients is embedded into the motion vector of the P-frame of each GOP by a reversible steganography algorithm. In the absence of an attack, the receiver can recover the DCT coefficients by extracting the auxiliary information in the vectors, ultimately recovering the video correctly. The watermarking scheme demonstrates strong robustness even when it suffers from malicious attacks such as recompression attacks and requantization attacks. The experimental results demonstrate that the watermarking scheme proposed in this paper exhibits reversibility and high visual quality. Moreover, the scheme surpasses other comparable methods in the robustness test session. Full article

Telemedicine is now being used more frequently to evaluate patients with myasthenia gravis (MG). Assessing this condition involves clinical outcome measures, such as the standardized MG-ADL scale or the more complex MG-CE score obtained during clinical exams. However, human subjectivity limits the reliability of these examinations. We propose a set of AI-powered digital tools to improve scoring efficiency and quality using computer vision, deep learning, and natural language processing. This paper focuses on automating a standard telemedicine video by segmenting it into clips corresponding to the MG-CE assessment. This AI-powered solution offers a quantitative assessment of neurological deficits, improving upon subjective evaluations prone to examiner variability. It has the potential to enhance efficiency, patient participation in MG clinical trials, and broader applicability to various neurological diseases. Full article

Pancreatic cancer remains one of the most lethal malignancies due to its aggressive nature and resistance to conventional therapies. This study investigates the anti-proliferative, pro-apoptotic, and anti-migratory effects of Gemcitabine (GC) and Withaferin A (WFA) on pancreatic cancer cell lines PANC-1 and Hs766t. The MTS assay revealed that both compounds effectively inhibit cell proliferation, with WFA showing a stronger effect in Hs766t cells. Flow cytometry analysis demonstrated that GC and WFA, particularly in combination, significantly induce apoptosis in both cell lines. Migration assays confirmed the potent inhibition of cell migration by both compounds, with the combination treatment being the most effective. Furthermore, actin cytoskeleton analysis indicated substantial changes in cell morphology and stiffness, suggesting that GC and WFA disrupt the structural integrity of cancer cells. Additionally, the study highlights a ROS-mediated mechanism underlying the effects of GC and WFA, as evidenced by increased ROS levels following treatment, which were attenuated by N-acetylcysteine. Importantly, NF-κB activity was significantly modulated, with WFA reducing NF-κB activation induced by GC, potentially contributing to the synergistic pro-apoptotic effect of the combination. These findings suggest that the combination of GC and WFA may offer a synergistic therapeutic approach for treating pancreatic cancer by targeting multiple aspects of tumor cell behavior. Full article

The development of telemedicine technology has provided new avenues for the diagnosis and treatment of patients with DME, especially after anti-vascular endothelial growth factor (VEGF) therapy, and accurate prediction of patients’ visual acuity (VA) is important for optimizing follow-up treatment plans. However, current automated prediction methods often require human intervention and have poor interpretability, making it difficult to be widely applied in telemedicine scenarios. Therefore, an efficient, automated prediction model with good interpretability is urgently needed to improve the treatment outcomes of DME patients in telemedicine settings. In this study, we propose a multimodal algorithm based on a semi-supervised learning framework, which aims to combine optical coherence tomography (OCT) images and clinical data to automatically predict the VA values of patients after anti-VEGF treatment. Our approach first performs retinal segmentation of OCT images via a semi-supervised learning framework, which in turn extracts key biomarkers such as central retinal thickness (CST). Subsequently, these features are combined with the patient’s clinical data and fed into a multimodal learning algorithm for VA prediction. Our model performed well in the Asia Pacific Tele-Ophthalmology Society (APTOS) Big Data Competition, earning fifth place in the overall score and third place in VA prediction accuracy. Retinal segmentation achieved an accuracy of 99.03 ± 0.19% on the HZO dataset. This multimodal algorithmic framework is important in the context of telemedicine, especially for the treatment of DME patients. Full article

Phenylketonuria (PKU) is an inherited metabolic disorder that requires lifelong adherence to a low-phenylalanine (Phe) diet to prevent severe neurological complications. However, maintaining dietary adherence can be challenging for patients and their families. This systematic review aimed to comprehensively evaluate the factors affecting adherence to a low-Phe diet in patients with PKU. A systematic search of multiple databases was conducted, and 49 studies were included in the final analysis. The quality of evidence was assessed using the Joanna Briggs Institute levels of evidence and the Quality Assessment with Diverse Studies tool. The review identified four main categories of factors influencing dietary adherence: family-related factors (social, psychological, behavioral, and educational), patient-specific factors (psychological, behavioral, educational, and demographic), environmental factors (healthcare professional support, educational and camp-based interventions, and the COVID-19 pandemic), and therapy-related factors (protein substitute formulation, clinic visits, blood tests, and telemedicine). The findings highlight the complex interplay between elements contributing to dietary adherence in PKU patients and underscore the importance of a multifaceted approach to support patients and their families. Future research should prioritize high-quality longitudinal and experimental studies to provide stronger evidence for the PKU community. Full article

Background: As the elderly population rapidly grows, age-related health issues are increasing. Telemedicine helps older adults adapt by providing efficient and accessible health management and medical services. Objectives: This study employs bibliometric analysis to examine research focus areas, emerging trends, and collaboration networks in telemedicine for older adults over the past three decades. Methods: The Web of Science Core Collection served as the primary data source for the publications on telemedicine and the elderly since the database’s inception through June 2024. Using CiteSpace.6.2.R4 software, keyword and collaboration network visualizations were generated, including clusters, co-authors, and co-citations. Results: This study analyzed 586 papers from 252 countries or regions, which were published across 246 journals and written by 2750 authors. Conclusions: The analysis revealed three primary research directions encompassing 42 clusters: (1) health literacy and technology adaptation; (2) telemedicine technology and health management; and (3) social interaction and economic impact. Research hotspots include elderly fitness, mobile health, technology acceptance, telemedicine, elderly care, and health literacy. Despite the potential benefit of telemedicine, challenges persist in areas such as technology acceptance, usability, effectiveness, service quality, and privacy concerns. This review provides a comprehensive overview of current research on telemedicine for the elderly and highlights emerging trends in the field. Full article

Protecting sensitive patient data, such as electrocardiogram (ECG) signals, during RF wireless transmission is essential due to the increasing demand for secure telemedicine communications. This paper presents an innovative chaotic-based encryption system designed to enhance the security and integrity of telemedicine data transmission. The proposed system utilizes a multi-scroll chaotic system for ECG signal encryption based on master–slave synchronization. The ECG signal is encrypted by a master system and securely transmitted to a remote location, where it is decrypted by a slave system using an extended state observer. Synchronization between the master and slave is achieved through the Lyapunov criteria, which ensures system stability. The system also supports Orthogonal Frequency Division Multiplexing (OFDM) and adaptive n-quadrature amplitude modulation (n-QAM) schemes to optimize signal discretization. Experimental validations with a custom transceiver scheme confirmed the system’s effectiveness in preventing channel overlap during 2.5 GHz transmissions. Additionally, a commercial RF Power Amplifier (RF-PA) for LTE applications and a development board were integrated to monitor transmission quality. The proposed encryption system ensures robust and efficient RF transmission of ECG data, addressing critical challenges in the wireless communication of sensitive medical information. This approach demonstrates the potential for broader applications in modern telemedicine environments, providing a reliable and efficient solution for the secure transmission of healthcare data. Full article

Hepatitis C (HCV) treatment for people who use drugs (PWUD) decreases injection drug use and injection equipment sharing. We examined changes in injection drug use and injection equipment sharing following HCV treatment in a randomized trial comparing peer-assisted telemedicine for HCV treatment (TeleHCV) versus peer-assisted usual care in rural PWUD. We hypothesize that TeleHCV reduces risky behaviors and peers facilitate this change. We used mixed-effects logistic regression to describe participant-level (n = 203) associations between both injection drug use and injection equipment sharing and randomized groups, frequency of peer contact, HCV treatment initiation, HCV cure, and time. Risky behaviors were surveyed at baseline and 12 and 36 weeks after HCV treatment completion. Injection drug use declined more over time in TeleHCV participants vs. control at 12 weeks (adjusted odds ratio [aOR] = 0.42, 95% CI 0.20–0.87, p = 0.02) and 36 weeks (aOR = 0.48, 95% CI 0.21–1.08, p = 0.076). Injection drug use decreased more with a greater number of peer interactions, with reductions among participants in the 3rd quartile exceeding those in the 1st quartile of peer interactions at 12 weeks (aOR = 0.75, 95% CI 0.57–0.99, p = 0.04). Similarly, injection equipment sharing decreased over time, with reductions among participants in the 3rd quartile exceeding those in the 1st quartile of peer interactions at 36 weeks (aOR = 0.08, 95% CI 0.01–0.97, p = 0.047). Peer-assisted telemedicine for HCV treatment decreases injection drug use and injection equipment sharing; peers contribute to this effect. Full article

Introduction. Pediatric traumatology is a complex field that requires a comprehensive understanding of physeal development, remodeling potential, and the ossification process in order to ensure appropriate patient treatment. The objective of this study was to assess the willingness of practicing physicians to participate in a telemedicine collaboration aimed at enhancing the exchange between the outpatient and inpatient sectors and promoting the digitalization of the pediatric sector. This is in response to the growing significance of digitalization in the medical field. Methods. A survey consisting of 15 items was sent to 800 practicing trauma surgeons, pediatric surgeons, and pediatricians within a 100 km radius of Hamburg, Germany. The survey included questions about the respondents’ professional experience and telemedicine experience, as well as inquiries about possible telemedicine collaborations. Results. The response rate was 19.3%. Less than half of the participants already used telemedicine in daily practice. In general, 75% of respondents expressed an interest in collaborating with the inpatient sector. The most common reasons for hospital referral were the need for surgery, inadequate treatment of children in practice and co-assessment. The majority were in favor of flexible communication, either via video telephony, imaging applications like or messaging applications. Conclusions. The study revealed a high level of interest in telemedicine collaboration. Information exchange should be tailored to individual needs, with practitioners requiring a versatile and personalized approach that includes imaging. Strict enforcement of data protection regulations is essential. Further research is needed to evaluate the effectiveness of telemedicine collaboration in the treatment of pediatric trauma in both hospital and outpatient settings. Full article

Deep brain stimulation (DBS) for Parkinson’s disease (PD) often necessitates frequent clinic visits for stimulation program optimization, with limited experience in remote patient management. Due to the resource-intensive nature of these procedures, we investigated a way to simplify stimulation optimization for these patients that allows for the continuous monitoring of symptoms while also reducing patient burden and travel distances. To this end, we prospectively recruited ten patients treated with DBS for PD to evaluate the feasibility of telemedicinal optimization in a home-based setting. Patients recorded daily videos of a modified Unified Parkinson’s Disease Rating Scale (UPDRS) III, which experienced DBS physicians located at the clinic assessed to provide instructions on adjusting stimulation settings using a handheld programmer with previously set programs as well as patient amplitude control. This study concluded with significant improvements in participants’ motor status as measured by the UPDRS-III (p = 0.0313) compared to baseline values. These findings suggest that remote video-guided optimization of DBS settings is feasible and may enhance motor outcomes for patients. Full article

Telepharmacy education should be incorporated into the curricula due to its beneficial effects on students, providing pharmacy services during their practice. Therefore, this study aims to explore the knowledge and perceptions of pharmacy students regarding the integration of telepharmacy services into their education curriculum in Saudi Arabia. A cross-sectional study was conducted using an online survey from 1 June to 30 September 2023, among pharmacy students from five universities in Saudi Arabia. The questionnaire was divided into three sections, and descriptive statistics and a generalized linear model were used for analysis. A total of 523 pharmacy students participated. Approximately half of the students were aware of telepharmacy, and only one-quarter had studied it as part of their curriculum. Students believed that telepharmacy education should cover communication, reimbursement, and training for virtual patient interactions. There was a significant positive correlation (p < 0.0001) between the knowledge and perception scores. In addition, students who had heard about telepharmacy before and those with a “somewhat” confidence level showed a significantly positive correlation with knowledge scores (p = 0.01). In conclusion, perception scores, students who had heard of telepharmacy, and those with a “somewhat” confidence level were all positively correlated with pharmacy students’ understanding of telepharmacy. This study underscores the importance of integrating telepharmacy education and practical training into pharmacy curricula to prepare future pharmacists for the evolving healthcare landscape. Full article

The COVID-19 pandemic has significantly accelerated the adoption of telemedicine and digital health technologies, revealing their immense potential in managing cancer patients effectively. This article explores the impact of recent technological developments and widened consumer perspectives on personalised healthcare and patient awareness, particularly in oncology. Smartphones and wearable devices have become integral to daily life, promoting healthy lifestyles and supporting cancer patients through remote monitoring and health management. The widespread use of these devices presents an unprecedented opportunity to transform clinical trials and patient care by offering convenient and accessible means of collecting health data continuously and non-invasively. However, to fully harness their potential, it is crucial to establish standardised methods for measuring patient metrics to ensure data reliability and validity. This article also addresses the challenges of integrating these technologies into clinical practice, such as cost, patient and professional reluctance, and technological oversaturation. It emphasises the need for continuous innovation, the development of robust digital infrastructures, and the importance of fostering a supportive environment to integrate these advancements permanently. Ultimately, the convergence of technological innovation and personalised healthcare promises to enhance patient outcomes, improve quality of life, and revolutionise cancer management in the post-COVID era. Full article

The adoption of telemedicine among the elderly is vital due to their unique healthcare needs and growing engagement with technology. This study explores the factors influencing their adoption behaviors, identifying both facilitating and inhibiting elements. While previous research has examined these factors, few have empirically assessed the simultaneous influence of barriers and enablers using a sample of elderly individuals. Using behavioral reasoning theory (BRT), this research investigates telehealth adoption behaviors of the elderly in India. A conceptual model incorporates both “reasons for” and “reasons against” adopting telehealth, capturing the nuanced dynamics of adoption behaviors. Data from 375 elderly individuals were collected to validate the model through structural equation modeling. The findings reveal that openness to change significantly enhances attitudes towards telehealth and “reasons for” adoption, influencing behaviors. This research contributes to the healthcare ecosystem by improving the understanding of telehealth adoption among the elderly. It validates the impact of openness to change alongside reasons for and against adoption, refining the understanding of behavior. By addressing impediments and leveraging facilitators, this study suggests strategies to maximize telehealth usage among the elderly, particularly those who are isolated, improving their access to medical services. Full article

This study provides an overview of trends and evolution in International Organization for Standardization (ISO) implementation in healthcare over the past three decades, useful for researchers, practitioners, and policymakers in the sector. As an additional contribution, we propose the NU-index, which allows the evaluation of authors’ scientific output in a comprehensive way that will be valuable for researchers, institutions, and funding agencies seeking to assess researcher performance more accurately and understandably. A bibliometric analysis of 476 scientific articles from the Scopus Database was conducted, examining the scientific output, key authors, high-impact journals, and frequent keywords using VOSviewer, Bibliometrix library, and statistical analysis. Results reveal a significant increase in publications on ISO standards in healthcare since 2009, particularly in areas such as telemedicine, artificial intelligence, and information security. The emergence of ISO 11073 (health informatics) and ISO 13606 (electronic health records) highlights a growing trend towards information and communication technologies. Despite reported implementation barriers, such as lack of top management commitment and associated costs, adoption of these standards is increasing due to the demand for high-quality healthcare services and the need to comply with regulatory requirements. Full article

Background: The need for telepractice and digital treatment has increased due to issues this revision.regarding medical access and the COVID-19 pandemic. However, in many countries, telepractice is rarely performed. The purpose of this pilot study was to describe the detailed process of telepractice in patients with hyperfunctional voice disorder and investigate its effects. Methods: The three subjects who were enrolled in this pilot study had hyperfunctional voice disorders. The evaluation was performed face to face. Auditory perceptual evaluation, acoustic evaluation, aerodynamic evaluation, patient self-evaluation, and interviews were conducted. Treatment was delivered by telepractice using a smartphone application. Results: In quantitative analysis of auditory perceptual evaluation, acoustic evaluation, aerodynamic evaluation, and patient self-evaluation, all subjects showed improved voice after treatment. In-depth analysis of telepractice was performed through the interview. Conclusions: Telepractice was effective in patients with voice disorders, and the patients were satisfied with this approach. In addition to this pilot study, further large-scale studies are required, but telemedicine may improve treatment outcomes and patient satisfaction in cases where medical access is limited or during outbreaks of respiratory infections like COVID-19. Full article