Remote Medical Care Research Articles

The optimal selection of mother wavelet function for analysis remote photoplethysmographic signals

Analysis of remote photoplethysmography signals is important for non-invasive real-time monitoring of the cardiovascular system. To prevent cardiovascular diseases, it is necessary to predict the disease, support remote medical care and integration with telemedicine. The aim of the work is to analyze the low-quality signal of a remote photoplethysmogram based on a wavelet transformation and selection of the corresponding mother wavelet function. The developed approach provides a wavelet analysis of the remote photoplethysmogram signal by means of the optimal choice of the mother wavelet function, which allows analyzing the cardiovascular system in the frequency-time domain. In accordance with the developed approaches, the approximation of the obtained data to the signals obtained by contact is more than 93% and thus confirms the possibility of using frequency-time signal analysis for remote photoplethysmography. On the basis of the wavelet transform, a principle has been formed that ensures obtaining a true plethysmogram without interference and noise for further study and analysis of the human cardiovascular system.

APPLICATION OF COMPUTERISED TECHNOLOGIES IN THE REHABILITATION OF PATIENTS WITH STROKE CONSEQUENCES

A stroke is a sudden onset of focal or generalized impairment of brain function due to vascular causes only, which is related to cerebral blood flow and lasts for more than 24 hours. Cerebral stroke remains the second leading cause of death and the third most significant cause of disability in the world. Over the past 30 years, the absolute number of cases of this disease has increased by 70%, the prevalence by 85%, with a 43% increase in mortality rates. According to the latest Global Burden of Disease (GBD) analysis, in 2019, there were about 12.2 million stroke cases, 143 million disability-adjusted life years and 6.6 million deaths worldwide, 86% of which occurred in low- and lower-middle-income countries. Purpose to analyse and systematise the use of computerised technologies in the rehabilitation of patients with stroke consequences. Materials and methods. To achieve the objectives of the research, the researchers analysed scientific literature and systematised information using electronic databases such as PubMed, Google Scholar and others. Research results. Traditional methods have proven their effectiveness and are widely used in the practice of rehabilitating patients after stroke. However, with the development of science and technology, there is a need to find new approaches to therapy that can provide a more comprehensive and effective treatment of this pathology. Today, computerized technologies deserve special attention in the rehabilitation of patients after stroke, namely robotic systems, specially designed video games and virtual reality, and TV rehabilitation. Robotic systems are devices that automate various tasks and processes. They can be programmed to perform certain functions with high accuracy and repeatability. In rehabilitation, such systems help to restore motor functions, support physical activity, and facilitate recovery from injuries or illnesses, including stroke. Video games and virtual reality technologies are examples of exciting and fun rehabilitation for stroke patients. Traditional therapies can be complex and tedious to repeat, making it less likely that patients will do them at home. Physical therapists are finding that video games are more engaging and easier to incorporate into home treatment regimens. Tele-rehabilitation after stroke is a form of remote medical care that allows patients to receive rehabilitation services via the Internet or other telecommunication technologies. This provides access to the necessary therapy regardless of the patient's place of residence. Conclusions. Computerized technology significantly improves the rehabilitation of patients with stroke. Robotic systems provide high precision and control during movements, which avoids incorrect exercise and reduces the risk of re-injury, regularity of training, and patient comfort. In addition, many robotic systems have built-in sensors that allow you to track the patient's progress and provide feedback to both the patient and the doctor. This helps to adjust the rehabilitation programme according to the patient's needs. The use of video games and virtual reality in stroke rehabilitation offers numerous benefits, including increased motivation, improved motor and cognitive function, psychological support, and social interaction. Tele-rehabilitation after stroke is an innovative approach to patient recovery, providing access to rehabilitation services regardless of where they live.

Multifunctional Human-Computer Interaction System Based on Deep Learning-Assisted Strain Sensing Array.

Continuous and reliable monitoring of gait is crucial for health monitoring, such as postoperative recovery of bone joint surgery and early diagnosis of disease. However, existing gait analysis systems often suffer from large volumes and the requirement of special space for setting motion capture systems, limiting their application in daily life. Here, we develop an intelligent gait monitoring and analysis prediction system based on flexible piezoelectric sensors and deep learning neural networks with high sensitivity (241.29 mV/N), quick response (66 ms loading, 87 ms recovery), and excellent stability (R2 = 0.9946). The theoretical simulations and experiments confirm that the sensor provides exceptional signal feedback, which can easily acquire accurate gait data when fitted to shoe soles. By integrating high-quality gait data with a custom-built deep learning model, the system can detect and infer human motion states in real time (the recognition accuracy reaches 94.7%). To further validate the sensor's application in real life, we constructed a flexible wearable recognition system with human-computer interaction interface and a simple operation process for long-term and continuous tracking of athletes' gait, potentially aiding personalized health management, early detection of disease, and remote medical care.

Rehab-AMD: co-design of an application for visual rehabilitation and monitoring of Age-related Macular Degeneration

BackgroundThe increasing demand for remote medical care, driven by digital healthcare advancements and the COVID-19 pandemic, necessitates effective solutions tailored to patients and healthcare practitioners. Co-design, involving collaboration between software developers, patients, and healthcare practitioners, prioritizes end-user needs. Research indicates that integrating patient perspectives enhances user experience and usability. However, its application in healthcare has been limited to small projects. This work focuses on co-designing a technological solution to enhance the monitoring and visual rehabilitation of individuals with Age-Related Macular Degeneration (AMD), a condition that significantly impacts the quality of life in people over 60. Current vision rehabilitation systems lack personalization, motivation, and effective progress monitoring. Involving patients and healthcare practitioners in the design process aims to ensure the final product meets their needs.MethodsThe project employs iterative and collaborative principles, involving a vision rehabilitation expert and two AMD patients as active users in the application’s development and validation. The process begins by establishing requirements for user accounts and rehabilitation exercises. It continues with an initial approach extended through user validation. Co-design is facilitated by specific workshops marking each project iteration, totaling four workshops, along with continuous communication sessions between experts and developers to validate design decisions. Initial requirements gathering and constant feedback from end-users, the visual rehabilitator, and patients are crucial for refining the product effectively.ResultsThe workshops produced a prototype featuring a test to monitor changes and progression and 15 visual rehabilitation exercises. Numerous patient and vision rehabilitation-driven software modifications led to a final design that is responsive and adaptive to end-user needs.ConclusionsThe Rehab-AMD pilot project aims to develop a collaborative and adaptive software solution for AMD rehabilitation by actively involving stakeholders and applying iterative design principles. Co-design in the Rehab-AMD solution proves to be a methodology that identifies usability issues and needs from the initial design stages. This approach ensures that software developers create a final product that is genuinely useful and manageable for people with AMD and the targeted vision rehabilitators.

Telemedicine Alert API Engine System for Vital Signs.

Telemedicine is used to assist and support remote medical care for patients. Our objective was to build up a REST Webservices alert engine that receives clinical parameters from patients of vital signs and basic laboratories to monitor patients remotely. We built a REST API using FHIR, so it can interoperate with other applications, send data to be processed, and receive a response. If the API detects a health risk situation, it sends an alert about the medical parameters that are controlled. The results of the processed data, news and alert, can return synchronously or asynchronously, at the same time that the data to be processed is being sent. The alerts generated can be automatically sent to a web service, mail or WhatsApp of the physician. The alert message comes out as normal, low, medium and high risk. The presented approach establishes communication that enables timely health information exchange. We conducted an experiment (with fictitious data) where we sent several queries by Postman. Finally, we evaluated the communication to be successful by manual checking. The use of the API significantly improves the monitoring of chronic patients. Many works show the effectiveness of telemedicine to improve the control of certain chronic diseases. In addition, telemedicine interventions were also found to significantly improve other health outcomes. Our API enables us to transfer data and produce alerts successfully. This gives us hope that a future with ubiquitous healthcare information interoperability is possible using our system.

Prognosis Prediction of Sudden Sensorineural Hearing Loss Using Ensemble Artificial Intelligence Learning Models.

We used simple variables to construct prognostic prediction ensemble learning models for patients with sudden sensorineural hearing loss (SSNHL). Retrospectively study. Tertiary medical center. 1,572 patients with SSNHL. Prognostic. We selected four variables, namely, age, days after onset of hearing loss, vertigo, and type of hearing loss. We also compared the accuracy between different ensemble learning models based on the boosting, bagging, AdaBoost, and stacking algorithms. We enrolled 1,572 patients with SSNHL; 73.5% of them showed improving and 26.5% did not. Significant between-group differences were noted in terms of age ( p = 0.011), days after onset of hearing loss ( p < 0.001), and concurrent vertigo ( p < 0.001), indicating that the patients who showed improving to treatment were younger and had fewer days after onset and fewer vertigo symptoms. Among ensemble learning models, the AdaBoost algorithm, compared with the other algorithms, achieved higher accuracy (82.89%), higher precision (86.66%), a higher F1 score (89.20), and a larger area under the receiver operating characteristics curve (0.79), as indicated by test results of a dataset with 10 independent runs. Furthermore, Gini scores indicated that age and days after onset are two key parameters of the predictive model. The AdaBoost model is an effective model for predicting SSNHL. The use of simple parameters can increase its practicality and applicability in remote medical care. Moreover, age may be a key factor influencing prognosis.

Analysis of the demand for medical services using digital programs in the Russian healthcare system: an overview of trends

The research conducted in this article has determined that among Russians, preference for private medical services, including through online technologies, is given for the following reasons: the speed of service provision - 45.1%; lack of queues (44%); quality of medical procedure (39.8%); ease of making an appointment (32.1%); high professional level of the doctor (24.4%). Given the fact that the cost of medical services at a personal appointment is increasing, it is safe to say that the types and forms of services in the format of remote medical care will certainly increase in number and may become the most important trend in 2024 and subsequent years. An important factor in the availability and satisfaction of medical services, and hence its demand, is the use of digital technologies and the direction of development of programs using artificial intelligence in medicine. The article provides an overview of the artificial intelligence resources used and implemented in medicine and healthcare in Russia, and the prospects for their development in the short term.

Distance follow-up by a remote medical care centre improves adherence to CPAP in patients with obstructive sleep apnoea over the short and long term.

Adherence to continuous positive air pressure (CPAP) in patients with obstructive sleep apnoea (OSA) has remained invariably low over the last decades. Remote monitoring of the nocturnal CPAP treatment, within telemedicine (TM)-based follow-up programs, in these patients has been suggested as a potential tool to improve adherence and release the workload of sleep units. The aim of this study was therefore to assess whether a follow-up program carried out by a Remote Medical Care Centre (RMCC), outside the sleep unit, improves adherence to CPAP in the short and long term in patients with OSA. In this pilot protocol, we enrolled 37 patients starting CPAP in our Sleep Centre (SC). After three months of standard care in our SC, patients initiated a six-month remote follow-up carried out by the RMCC, functioning as an intermediary between patients and SC. Monthly reports and indication for face-to-face visits were sent to the SC for six months. After this period patients returned to usual care for one year. Results were compared with those obtained in 38 patients (controls) followed with usual care over the same time range. Mean nightly use of CPAP increased from 3.2 ± 2.4 h pre-RMCC to 5.2 ± 1.9 h post-RMCC (p < 0.0001). Nights/month of CPAP use improved from 19.8 ± 9.2 to 25.2 ± 2.5 (p < 0.05) and nights/month with CPAP use >4 h from 12.5 ± 10 to 21.03 ± 8.9 (p < 0.05). This improvement remained stable after 12 months from the return of patients to usual care. No significant changes in CPAP use were observed in controls over the time. A six-month follow-up through a remote facility can significantly improve adherence to CPAP in the short and long term. This pilot study provides a solid base for the design of multicentre randomized trials focusing on new models which are able to increase the long-term efficacy of TM programs.

Questionnaire Survey on Perception and Attitude Toward of Remote Treatment by Korean Medicine Doctors

Objectives: Following the global COVID-19 pandemic, with the escalation of remote medical care formalization in Korea, there is a pressing need for objective data in the Korean medicine field to respond to remote treatment medical care policies. This study aims to investigate the perceptions and acceptance of remote treatments among Korean Medicine Doctors (KMDs).Methods: After expert reviews and pilot testing, the 31-question survey covered participant characteristics, experiences, forms, intentions, and perceptions related to Remote Treatments. The survey was electronically distributed to members of the Association of Korean Medicine, and 662 clinical KMDs provided valid responses.Results: Among respondents, 76.1% engaged in remote treatments, utilizing various platforms. Those with experience in Remote Treatments showed a significantly higher willingness to continue participating during the institutionalization process (p&lt;0.001). 49.7% of respondents stated that traditional Korean medicine is competitive in remote treatments, with the main reasons being the ability for regular management after herbal medication(26.1%) and increased patient satisfaction due to sufficient counseling compared to Western medicine(25.2%). Respondents preferred Remote Treatment conditions with a treatment time of less than 10 minutes(47.6%) and equivalent fees to in-person visits(45.6%). Regarding suitable intervention tools during Remote Treatment, respondents favored non-covered herbal prescriptions(39.0%), covered herbal granules(24.6%), and non-covered herbal granules(23.0%).Conclusion: This study investigated the perceptions and acceptance of KMDs regarding remote treatments. These findings provide valuable insights for policymakers aiming to establish effective policies for Remote Treatments suitable for the Korean medicine healthcare environment.

Neutrosophic Evaluation of Ethical Factors in Remote Medical Care

In the context of telemedicine and remote medical care, the evaluation of ethical factors plays a crucial role in ensuring the quality and safety of healthcare. This study employed neutrosophic logic and the Technique for Order of Preference by Similarity to the Ideal Solution (TOPSIS) method within a bipolar neutrosophic environment to assess relevant ethical factors. Within the scope of this research, an evaluation and selection process was undertaken for ethical factors influencing remote medical care through telemedicine. The results revealed that "Patient Autonomy in Remote Decision-Making" was the most influential factor. Neutrosophic logic and the TOPSIS method in a bipolar neutrosophic environment provided a robust and equitable tool for addressing the complexity of medical ethics in the era of telemedicine. This approach may contribute to the enhancement of the quality and safety of remote medical care.

Research on the Application of AI Combined with Remote Medical Care in the Context of Population Aging

Research on the Application of AI Combined with Remote Medical Care in the Context of Population Aging

DevOps for Telehealth Services: Accelerating Deployment and Scalability

The use of telehealth services is increasing rapidly to increase access and delivery of remote medical care. However, there are significant technical barriers to rapid and reliable deployment of these services and their ability to handle high patient volumes. This study looks at how DevOps approaches can benefit telehealth providers and let it to overcome this obstacle. To maximize software development and infrastructure management, DevOps focuses on collaboration between development and IT operations teams. Telehealth platforms can be deployed rapidly while leveraging key DevOps skills such as automation, infrastructure-to-code, monitoring, and continuous integration Studies show that these techniques also improve scalability to meet demand changes. This makes it possible for telehealth providers to deliver digitally enabled care to a larger patient base.

ORGANIZATIONAL SOLUTIONS TO INCREASE THE AVAILABILITY OF MEDICAL CARE TO PATIENTS WITH CARDIOVASCULAR DISEASES IN THE KEMEROVO REGION – KUZBASS

HighlightsWe have conducted the analysis of work processes in medical organizations of the Kemerovo region – Kuzbass providing cardiovascular care in the period 2021–2022. The results revealed key issues regarding personnel and organizational and methodological support of their work, and management of patients with high cardiovascular risk. Moreover, we have analyzed the availability of medical care for patients with cardiovascular diseases in the Kemerovo region – Kuzbass. Aim. To evaluate organizational solutions aimed to increase the availability of medical care for patients with cardiovascular diseases in the Kemerovo region – Kuzbass.Methods. The study involved analytical, statistical and direct observation methods for the analysis. Statistical data from Federal statistical survey forms based on the Federal State Statistics Service Order No. 985 dated 12/27/2022 (dated 10/27/2023) “On approval of Federal statistical survey forms with instructions on how to fill them out for organizations by the Ministry of Health of the Russian Federation of federal statistical observation in healthcare” (Form № 30 (annual), all-Russian classifier of management documentation code 0609362, Form N 14 (annual), all-Russian classifier of management documentation code 0609348), database on the provision of medical care, other relevant data from the Federal State Statistics Service, statistical data of the Central Research Institute of the Ministry of Health of the Russian Federation for the period from 2019–2022, and the results of an expert assessments of specialized Federal centers were studied.Results. In comparison with 2021, taking into account insufficient staffing of 59.5%, the number of cardiologists in the Kemerovo region decreased slightly. At the same time, there is a slight downward trend in the number of cardiologists with higher qualification, the percentage of doctors with higher qualification has decreased to 46.7% (of the total number of cardiologists). Regarding this profession, the availability of a doctor per 10,000 adults decreased by 10%, in 2022 the regional indicator was 19.8% lower than the national average, and 12% lower than the average for the Siberian Federal District. In the study period, some indicators displayed negative trends, indicating the presence of issues in medical organizations in the Kemerovo region, namely: the number of surgeries for acquired heart diseases decreased by 13.8%. The number of coronary artery bypass grafting surgeries decreased by 9.3%, per 1 million people in the region, this indicator remains 14% lower than the national value. The number of surgical procedures for rhythm disorders per 1 million population also 1.3% lower than the national value. The problem areas identified in the course of this study related to staffing, management of patients with high cardiovascular risk, organizational and methodological support for the work processes in medical organizations, served as the basis for the justification of the made organizational decisions.Conclusion. Organizational decisions taken in 2022 positively affected the availability of medical care for residents of the Kemerovo region – Kuzbass due to implementation of a systematic approach to cardiovascular risk management, with an emphasis on identifying patients at high-risk through additional diagnostic methods, the widespread introduction of remote medical care for the population and, as a result, an increase in the number of provided medical care procedures.

Organization of Remote Rehabilitation in the Russian Federation: a Literature Review

INTRODUCTION. The interruption of the recovery process and the absence of patients’ activities at home after discharge from a medical institution leads to the loss of results achieved at various stages of medical rehabilitation. In this regard, the remote (telemedicine) form of rehabilitation assistance is of particular importance.&#x0D; AIM. To present up-to-date data on the legal and regulatory framework for telemedicine in the Russian Federation, as well as an overview of domestic Internet platforms in the field of remote medical rehabilitation.&#x0D; MATERIALS AND METHODS. The search for normative legal acts was carried out on the “The official Internet portal of Legal Information” (www.pravo.gov.ru). The literature review was performed using the databases eLibrary, Cyberleninka, PubMed, Scopus, Web of Science (Core Collection) and Google Scholar by July 31, 2023 for the following keywords: telemedicine, remote physical rehabilitation, medical rehabilitation, functional recovery.&#x0D; RESULTS. The article elaborates on the legal and regulatory framework of telemedicine in the Russian Federation, provides a list of domestic Internet portals that are now being employed to provide remote medical care.&#x0D; CONCLUSION. The remote form of arranging rehabilitation is supported by the regulatory and legal framework and has promising outlooks for development due to the advent of new information technologies that allow for active communication between a medical worker and a patient. Nevertheless, the issues of effectiveness and safety of remote physical rehabilitation remain insufficiently studied, therefore, it is necessary to conduct randomized comparative studies analyzing long-term results.

Swallowing sound evaluation using an electronic stethoscope and artificial intelligence analysis for patients with amyotrophic lateral sclerosis.

Non-invasive, simple, and repetitive swallowing evaluation is required to prevent aspiration pneumonia in neurological care. We investigated the usefulness of swallowing sound evaluation in patients with amyotrophic lateral sclerosis (ALS) using our new electronic stethoscope artificial intelligence (AI) analysis tool. We studied patients with ALS who provided written informed consent. We used an electronic stethoscope, placed a Bluetooth-enabled electronic stethoscope on the upper end of the sternum, performed a 3-mL water swallow three times, and remotely identified the intermittent sound components of the water flow caused at that time by AI, with the maximum value as the swallowing sound index. We examined the correlation between the swallowing sound index and patient background, including swallowing-related parameters. We evaluated 24 patients with ALS (age 64.0 ± 11.8 years, 13 women, median duration of illness 17.5 months). The median ALS Functional Rating Scale-Revised (ALSFRS-R) score was 41 (minimum 18, maximum 47). In all cases, the mean swallowing sound index was 0.209 ± 0.088. A multivariate analysis showed that a decrease in the swallowing sound index was significantly associated with a low ALSFRS-R score, an ALSFRS-R bulbar symptom score, % vital capacity, tongue pressure, a Mann Assessment of Swallowing Ability (MASA) score, and a MASA pharyngeal phase-related score. Swallowing sound evaluation using an electronic stethoscope AI analysis showed a correlation with existing indicators in swallowing evaluation in ALS and suggested its usefulness as a new method. This is expected to be a useful examination method in home and remote medical care.

Markerless human pose estimation for biomedical applications: a survey

Markerless Human Pose Estimation (HPE) proved its potential to support decision making and assessment in many fields of application. HPE is often preferred to traditional marker-based Motion Capture systems due to the ease of setup, portability, and affordable cost of the technology. However, the exploitation of HPE in biomedical applications is still under investigation. This review aims to provide an overview of current biomedical applications of HPE. In this paper, we examine the main features of HPE approaches and discuss whether or not those features are of interest to biomedical applications. We also identify those areas where HPE is already in use and present peculiarities and trends followed by researchers and practitioners. We include here 25 approaches to HPE and more than 40 studies of HPE applied to motor development assessment, neuromuscolar rehabilitation, and gait &amp;amp; posture analysis. We conclude that markerless HPE offers great potential for extending diagnosis and rehabilitation outside hospitals and clinics, toward the paradigm of remote medical care.

The telemedicine and digital technologies in education programs of training medical personnel of higher qualification

The article considers application of telemedicine and digital technologies in educational programs of training medical personnel in residency and graduate school for the Russian health care system. The possibilities of telemedicine and digital technologies that currently are in use for remote medical care, consultations of medical workers by qualified medical specialists and for training and re-training of medical personnel are investigated. The key topics of modern health care are improvement of system of training medical manpower, personalization of medical care in health care, individualization of professional orientation in the process of continuing medical education and current methods of information environment management in health care sector. The conclusion is made that owing to new technologies,such innovations as telemedicine, artificial intelligence, medical decision-making systems, remote platforms of patient health monitoring and other modern inventions are implemented into health care. The purpose of the study is to examine impact of transformational processes in higher medical education in epoch of digitization.

Analysis of patient-physician portal secure message content and the associated cost savings in oncology practice.

1503 Background: The consistent utilization of secure messaging (“SM”) since the onset of the COVID-19 pandemic has provided cancer patients with unprecedented access to their medical providers, resulting in reduced out-of-pocket costs for patients at the expense of increased workload for oncologists. Herein we analyze oncology SM content and report estimated cost savings from reduced traditional clinic visits. Methods: This population-based retrospective cohort study examined the content of patient-initiated SM threads exchanged through the patient portal website or app over a one-year period (6/1/21 to 5/31/22) at 22 Kaiser Permanente Northern California Oncology practices. A trained physician researcher reviewed a random sample of 500 SM threads and categorized them by message content type, acuity, and appropriate level of service. Standard costs were applied using the average of 2021 and 2022 Center for Medicare Services physician fee schedule and US patient average specialty copayment. Results: During the study period, 49,230 patients initiated 398,835 unique SM threads to 238 oncology providers. The average number of replies to patients’ initial messages was 2.6, with a mode of 1 (maximum 36). Of the SM threads reviewed, only 28.0% required oncologist expertise. Based on thread content, the remaining 72.0% may have been better managed by a nurse (35.4%), medical assistant (29.2%), primary care doctor (6.2%), or a different subspecialty provider (1.2%). Emergency care was required in 2.8% of the total threads reviewed. Significant medical care was provided to patients in 26.0% of the total SM threads which would traditionally require a billable visit (i.e., in-person, telephone, or video). We estimate that these clinical actions may represent 4,299,281.77 of savings in medical care (based on traditional 10-19-minute visits), and 4,562,672.40 in potentially avoided out-of-pocket co-pay costs for patients. Conclusions: Increased utilization of remote medical care and specifically SM has recently generated additional workload for oncologists that may have been more appropriately managed by alternative providers. The magnitude of unreimbursed medical care provided via SM and the use of SM by cancer patients for emergent medical situations creates an urgent need for new models to assist with practice management. An alternative architecture for triaging, managing, and billing SM that utilizes artificial intelligence, machine learning algorithms, or medical assistants, nurses, and other providers could help manage the burden experienced by oncologists.

Blockchain-Based Data Access Control and Key Agreement System in IoT Environment.

Recently, with the increasing application of the Internet of Things (IoT), various IoT environments such as smart factories, smart homes, and smart grids are being generated. In the IoT environment, a lot of data are generated in real time, and the generated IoT data can be used as source data for various services such as artificial intelligence, remote medical care, and finance, and can also be used for purposes such as electricity bill generation. Therefore, data access control is required to grant access rights to various data users in the IoT environment who need such IoT data. In addition, IoT data contain sensitive information such as personal information, so privacy protection is also essential. Ciphertext-policy attribute-based encryption (CP-ABE) technology has been utilized to address these requirements. Furthermore, system structures applying blockchains with CP-ABE are being studied to prevent bottlenecks and single failures of cloud servers, as well as to support data auditing. However, these systems do not stipulate authentication and key agreement to ensure the security of the data transmission process and data outsourcing. Accordingly, we propose a data access control and key agreement scheme using CP-ABE to ensure data security in a blockchain-based system. In addition, we propose a system that can provide data nonrepudiation, data accountability, and data verification functions by utilizing blockchains. Both formal and informal security verifications are performed to demonstrate the security of the proposed system. We also compare the security, functional aspects, and computational and communication costs of previous systems. Furthermore, we perform cryptographic calculations to analyze the system in practical terms. As a result, our proposed protocol is safer against attacks such as guessing attacks and tracing attacks than other protocols, and can provide mutual authentication and key agreement functions. In addition, the proposed protocol is more efficient than other protocols, so it can be applied to practical IoT environments.

Augmented Reality in Real-time Telemedicine and Telementoring: Scoping Review

Over the last decade, augmented reality (AR) has emerged in health care as a tool for visualizing data and enhancing simulation learning. AR, which has largely been explored for communication and collaboration in nonhealth contexts, could play a role in shaping future remote medical services and training. This review summarized existing studies implementing AR in real-time telemedicine and telementoring to create a foundation for health care providers and technology developers to understand future opportunities in remote care and education. This review described devices and platforms that use AR for real-time telemedicine and telementoring, the tasks for which AR was implemented, and the ways in which these implementations were evaluated to identify gaps in research that provide opportunities for further study. We searched PubMed, Scopus, Embase, and MEDLINE to identify English-language studies published between January 1, 2012, and October 18, 2022, implementing AR technology in a real-time interaction related to telemedicine or telementoring. The search terms were "augmented reality" OR "AR" AND "remote" OR "telemedicine" OR "telehealth" OR "telementoring." Systematic reviews, meta-analyses, and discussion-based articles were excluded from analysis. A total of 39 articles met the inclusion criteria and were categorized into themes of patient evaluation, medical intervention, and education. In total, 20 devices and platforms using AR were identified, with common features being the ability for remote users to annotate, display graphics, and display their hands or tools in the local user's view. Common themes across the studies included consultation and procedural education, with surgery, emergency, and hospital medicine being the most represented specialties. Outcomes were most often measured using feedback surveys and interviews. The most common objective measures were time to task completion and performance. Long-term outcome and resource cost measurements were rare. Across the studies, user feedback was consistently positive for perceived efficacy, feasibility, and acceptability. Comparative trials demonstrated that AR-assisted conditions had noninferior reliability and performance and did not consistently extend procedure times compared with in-person controls. Studies implementing AR in telemedicine and telementoring demonstrated the technology's ability to enhance access to information and facilitate guidance in multiple health care settings. However, AR's role as an alternative to current telecommunication platforms or even in-person interactions remains to be validated, with many disciplines and provider-to-nonprovider uses still lacking robust investigation. Additional studies comparing existing methods may offer more insight into this intersection, but the early stage of technical development and the lack of standardized tools and adoption have hindered the conduct of larger longitudinal and randomized controlled trials. Overall, AR has the potential to complement and advance the capabilities of remote medical care and learning, creating unique opportunities for innovator, provider, and patient involvement.