The worldwide impact of telemedicine during COVID-19: current evidence and recommendations for the future

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.

Remote, proactive, telephone based management of toxicity in outpatients during adjuvant or neoadjuvant chemotherapy for early stage breast cancer: pragmatic, cluster randomised trial

Objective To evaluate the effectiveness of remote proactive management of toxicities during chemotherapy for early stage breast cancer. Design Pragmatic, cluster randomised trial. Setting 20 cancer centres in Ontario, Canada, allocated by covariate constrained randomisation to remote management of toxicities or routine care. Participants All patients starting adjuvant or neoadjuvant chemotherapy for early stage breast cancer at each centre. 25 patients from each centre completed patient reported outcome questionnaires. Interventions Proactive, standardised, nurse led telephone management of common toxicities at two time points after each chemotherapy cycle. Main outcome measures The primary outcome, cluster level mean number of visits to the emergency department or admissions to hospital per patient during the whole course of chemotherapy treatment, was evaluated with routinely available administrative healthcare data. Secondary patient reported outcomes included toxicity, self-efficacy, and quality of life. Results Baseline characteristics of participants were similar in the intervention (n=944) and control arms (n=1214); 22% were older than 65 years. Penetration (that is, the percentage of patients who received the intervention at each centre) was 50-86%. Mean number of visits to the emergency department or admissions to hospital per patient was 0.91 (standard deviation 0.28) in the intervention arm and 0.94 (0.40) in the control arm (P=0.94); 47% (1014 of 2158 patients) had at least one visit to the emergency department or a hospital admission during chemotherapy. Among 580 participants who completed the patient reported outcome questionnaires, at least one grade 3 toxicity was reported by 48% (134 of 278 patients) in the intervention arm and by 58% (163 of 283) in the control arm. No differences in self-efficacy, anxiety, or depression were found. Compared with baseline, the functional assessment of cancer therapy trial outcome index decreased by 6.1 and 9.0 points in the intervention and control participants, respectively. Conclusions Proactive, telephone based management of toxicities during chemotherapy did not result in fewer visits to the emergency department or hospital admissions. With the rapid rise in remote care because of the covid-19 pandemic, identifying scalable strategies for remote management of patients during cancer treatment is particularly relevant. Trial registration ClinicalTrials.gov NCT02485678 .

Automatic Failure Recovery for Container-Based IoT Edge Applications

Recent years have seen the rapid adoption of Internet of Things (IoT) technologies, where billions of physical devices are interconnected to provide data sensing, computing and actuating capabilities. IoT-based systems have been extensively deployed across various sectors, such as smart homes, smart cities, smart transport, smart logistics and so forth. Newer paradigms such as edge computing are developed to facilitate computation and data intelligence to be performed closer to IoT devices, hence reducing latency for time-sensitive tasks. However, IoT applications are increasingly being deployed in remote and difficult to reach areas for edge computing scenarios. These deployment locations make upgrading application and dealing with software failures difficult. IoT applications are also increasingly being deployed as containers which offer increased remote management ability but are more complex to configure. This paper proposes an approach for effectively managing, updating and re-configuring container-based IoT software as efficiently, scalably and reliably as possible with minimal downtime upon the detection of software failures. The approach is evaluated using docker container-based IoT application deployments in an edge computing scenario.

Research on effects and influence by presenting information on priority order and oncoming vehicle to operators for teleoperation of multiple autonomous vehicles

With self-driving vehicles, it is possible to manage multiple vehicles from a remote location even if one observer does not have a driver in the driver’s seat. Therefore, demonstration experiments are being conducted in various places to remotely monitor two autonomous vehicles and operate them as needed. However, when one observer manages multiple vehicles, the amount of information that can be processed is limited. If we can assist with an appropriate amount of information, we may be able to manage more vehicles. In this study, we perform an experiment in which the priority and the type of assist information are changed and presented to the observer in the overtaking scene of a parked vehicle using a simulator. Focusing on the burden on the observer during remote management of multiple units, the purpose is to identify the information required for monitoring and reduce the burden from changes depending on the type of information to be assisted.

Prototyping IoT-Based Virtual Environments: An Approach toward the Sustainable Remote Management of Distributed Mulsemedia Setups

Business models built upon multimedia/multisensory setups delivering user experiences within disparate contexts—entertainment, tourism, cultural heritage, etc.—usually comprise the installation and in-situ management of both equipment and digital contents. Considering each setup as unique in its purpose, location, layout, equipment and digital contents, monitoring and control operations may add up to a hefty cost over time. Software and hardware agnosticity may be of value to lessen complexity and provide more sustainable management processes and tools. Distributed computing under the Internet of Things (IoT) paradigm may enable management processes capable of providing both remote control and monitoring of multimedia/multisensory experiences made available in different venues. A prototyping software to perform IoT multimedia/multisensory simulations is presented in this paper. It is fully based on virtual environments that enable the remote design, layout, and configuration of each experience in a transparent way, without regard of software and hardware. Furthermore, pipelines to deliver contents may be defined, managed, and updated in a context-aware environment. This software was tested in the laboratory and was proven as a sustainable approach to manage multimedia/multisensory projects. It is currently being field-tested by an international multimedia company for further validation.

The Rise of Wearable Devices during the COVID-19 Pandemic: A Systematic Review

The COVID-19 pandemic has wreaked havoc globally and still persists even after a year of its initial outbreak. Several reasons can be considered: people are in close contact with each other, i.e., at a short range (1 m), and the healthcare system is not sufficiently developed or does not have enough facilities to manage and fight the pandemic, even in developed countries such as the USA and the U.K. and countries in Europe. There is a great need in healthcare for remote monitoring of COVID-19 symptoms. In the past year, a number of IoT-based devices and wearables have been introduced by researchers, providing good results in terms of high accuracy in diagnosing patients in the prodromal phase and in monitoring the symptoms of patients, i.e., respiratory rate, heart rate, temperature, etc. In this systematic review, we analyzed these wearables and their need in the healthcare system. The research was conducted using three databases: IEEE Xplore®, Web of Science®, and PubMed Central®, between December 2019 and June 2021. This article was based on the PRISMA guidelines. Initially, 1100 articles were identified while searching the scientific literature regarding this topic. After screening, ultimately, 70 articles were fully evaluated and included in this review. These articles were divided into two categories. The first one belongs to the on-body sensors (wearables), their types and positions, and the use of AI technology with ehealth wearables in different scenarios from screening to contact tracing. In the second category, we discuss the problems and solutions with respect to utilizing these wearables globally. This systematic review provides an extensive overview of wearable systems for the remote management and automated assessment of COVID-19, taking into account the reliability and acceptability of the implemented technologies.