Smart Healthcare: Future Applications & Challenges

After the outbreak of corona virus, all counties are paying special attention to their healthcare infrastructure. During second phase of covid-19, entire world has seen health care crisis. Large number of people died globally. Entire world was affected mentally or physically. There is a great need to strengthen the healthcare infrastructure, to vaccinate the population against covid virus infection and to take proper precaution to avoid spread of the virus, so that the world will not see such deadly days again. This paper discusses how technologies like Internet of Things (IoT), Artificial Intelligence (AI), Drones etc can help in remote monitoring of patients, judicious hospital admission, conscious distribution of lifesaving drugs etc. Investment in technology with not only help in the reduction of spread of the virus but will also help in fighting with all other future pandemics. All the countries must have to invest more on latest technologies in their healthcare to make themselves ready for such future pandemics. When the things will improve, the new normal will be very much different from the life that was before pandemic. IoT, AI and other technologies will become the non-separatable part of our life. © 2023 Bharati Vidyapeeth, New Delhi.

Effect of covid-19 infection and preventive public health measures on haemodynamics, activity and quality of life in patients with pulmonary arterial hypertension

155 Figure 1 155 Figure 2Conflict of InterestNone

Effectiveness of dental monitoring system in orthodontics: A systematic review.

BACKGROUND: Dental monitoring (DM) constitutes a recent technological advance for the remote monitoring of patients undergoing an orthodontic therapy. Especially in times of health emergency crisis, the possibility of relying on remote monitoring could be particularly useful. OBJECTIVES: To assess the effectiveness of DM in orthodontic care. ELIGIBILITY: Studies conducted on healthy patients undergoing orthodontic care where DM was applied, assessing a change in treatment duration, emergency appointments, in-office visits, orthodontic relapse, early detection of orthodontic emergencies and improvement of oral health status. INFORMATION SOURCES: PubMed, Web of Science and Scopus were searched for publications until November 2022. RISK OF BIAS: Quality assessment was performed with the STROBE Checklist. DATA EXTRACTION: Data were extracted independently by two reviewers, and discrepancies were resolved with a third reviewer. INCLUDED STUDIES: Out of 6887 records screened, 11 studies were included. SYNTHESIS OF RESULTS: DM implemented to the standard orthodontic care was found to significantly decrease the number of in-office visits by 1.68-3.5 visits and showed a possible trend towards improvement of aligner fit. Conversely, evidence does not support a reduction of treatment duration and emergency appointments. The assessment of the remaining variables did not allow any qualitative synthesis. CONCLUSIONS: This review highlighted that DM implemented to standard orthodontic care can significantly decrease the number of in-office visits and may potentially result in an improved aligner fit. Due to the low quality of most of the included studies and the heterogeneity of the orthodontic system where DM was applied, studies with different investigation team and rigorous methodology are advocated.

Remote Management of Patients with Cardiac Implantable Electronic Devices during the COVID-19 Pandemic.

Remote monitoring (RM) is the newest function of cardiac implantable electronic devices (CIEDs). In our observational retrospective analysis, we aimed to assess whether telecardiology could be a safe alternative to routine outpatient examinations during the COVID-19 pandemic. The in- and outpatient visits, the number of acute cardiac decompensation episodes, the RM data from CIEDs, and general condition were examined via questionnaires (KCCQ, EQ-5D-5L). Regarding the enrolled 85 patients, the number of personal patient appearances was significantly lower in the year following the pandemic outbreak compared to the previous year (1.4 ± 1.4 and 1.9 ± 1.2, p = 0.0077). The number of acute decompensation events was five before and seven during lockdown (p = 0.6). Based on the RM data, there was no significant difference in heart failure (HF) markers (all related p > 0.05); only patient activity increased after restrictions were lifted compared to that before the lockdown (p = 0.03). During restrictions, patients reported increased anxiety and depression compared to their previous state (p < 0.001). There was no subjective change in the perception of HF symptoms (p = 0.7). Based on the subjective perception and CIED data, the quality of life of patients with CIED did not deteriorate during the pandemic, but their anxiety and depression intensified. Telecardiology may be a safe alternative to routine inpatient examination.

Telemedicine for Optimizing Secondary Prevention in Coronary Artery Bypass Grafting Patients during COVID-19 Pandemic.

(1) Background: The COVID-19 pandemic has introduced a major disruption to the delivery of secondary prevention measures in patients with established atherosclerotic cardiovascular disease (CVD). It required a rapid and widespread adoption of new medical services, including the use of telemedicine. This study aimed to examine the impact of COVID-19 on secondary prevention in patients with coronary artery bypass grafting (CABG) and to evaluate the effectiveness of the telemedicine application for the implementation of lifestyle change measures, remote monitoring, and treatment regimen adjustment; (2) Methods: This prospective study on 194 CABG patients evaluated three consecutive years between 2019 and 2022 in the pre-pandemic period by face-to-face visits and during the pandemic by teleconsultations or hybrid follow-up. Variables of interest were compared between four periods: pre-pandemic-pre-P (1 March 2019-29 February 2020), lockdown-Lock (1 March-31 August 2020), restrictive-pandemic-Restr-P (1 September 2020-28 February 2021), and relaxed-pandemic-Rel-P (1 March 2021-1 March 2022). (3) Results: The average values of the lipidogram, blood sugar, and uric acid increased during Lock and Restr-P, but, through the use of teleprevention, they returned to the pre-pandemic level or even below this level. The exception was blood sugar, which remained high in Rel-P. The number of newly diagnosed patients with diabetes also increased, with most of them having moderate forms of COVID. During Lock and Res-P, the percentage of obese, smoking, or hypertensive patients increased, but, through the use of teleprevention, we managed to reduce it, although it remained slightly higher than the pre-pandemic level. Physical activity decreased in the first year of the pandemic, but, in Rel-P, CABG patients became more active than before the pandemic (4) Conclusions: The use of telemedicine for cardiovascular secondary prevention allowed us to not only continue seeing CABG patients but, also, to adjust their medication and to expand cardiovascular preventive counseling and testing with favorable results, especially during the second year of the pandemic.

The Artificial Intelligence in Teledermatology: A Narrative Review on Opportunities, Perspectives, and Bottlenecks.

Artificial intelligence (AI) is recently seeing significant advances in teledermatology (TD), also thanks to the developments that have taken place during the COVID-19 pandemic. In the last two years, there was an important development of studies that focused on opportunities, perspectives, and problems in this field. The topic is very important because the telemedicine and AI applied to dermatology have the opportunity to improve both the quality of healthcare for citizens and the workflow of healthcare professionals. This study conducted an overview on the opportunities, the perspectives, and the problems related to the integration of TD with AI. The methodology of this review, following a standardized checklist, was based on: (I) a search of PubMed and Scopus and (II) an eligibility assessment, using parameters with five levels of score. The outcome highlighted that applications of this integration have been identified in various skin pathologies and in quality control, both in eHealth and mHealth. Many of these applications are based on Apps used by citizens in mHealth for self-care with new opportunities but also open questions. A generalized enthusiasm has been registered regarding the opportunities and general perspectives on improving the quality of care, optimizing the healthcare processes, minimizing costs, reducing the stress in the healthcare facilities, and in making citizens, now at the center, more satisfied. However, critical issues have emerged related to: (a) the need to improve the process of diffusion of the Apps in the hands of citizens, with better design, validation, standardization, and cybersecurity; (b) the need for better attention paid to medico-legal and ethical issues; and (c) the need for the stabilization of international and national regulations. Targeted agreement initiatives, such as position statements, guidelines, and/or consensus initiatives, are needed to ensure a better result for all, along with the design of both specific plans and shared workflows.

Remote Monitoring for Heart Failure Management at Home.

Early telemonitoring of weights and symptoms did not decrease heart failure hospitalizations but helped identify steps toward effective monitoring programs. A signal that is accurate and actionable with response kinetics for early re-assessment is required for the treatment of patients at high risk, while signal specifications differ for surveillance of low-risk patients. Tracking of congestion with cardiac filling pressures or lung water content has shown most impact to decrease hospitalizations, while multiparameter scores from implanted rhythm devices have identified patients at increased risk. Algorithms require better personalization of signal thresholds and interventions. The COVID-19 epidemic accelerated transition to remote care away from clinics, preparing for new digital health care platforms to accommodate multiple technologies and empower patients. Addressing inequities will require bridging the digital divide and the deep gap in access to HF care teams, who will not be replaced by technology but by care teams who can embrace it.

Creation of pacemaker remote monitoring networks between hospital and pharmacies during Covid-19 outbreak.

INTRODUCTION: Remote Monitoring (RM) of Cardiac Implantable Electronic Devices (CIEDs) is proven to be safe and efficient. It has been adopted in our center since years. At the time of the recent Covid-19 outbreak, we introduced and tested a collaborative organizational model, through a new RM device (Totem), creating a network with the surrounding territory and limiting CIED patients' presence in hospital. METHODS: We involved 4 neighbor pharmacies where Totem devices were installed; we called and informed 64 patients with Totem compatible pacemaker (PM) about the possibility to perform their PM follow-up (FU) in-pharmacy; 58 gave their consent and their data were inserted into our RM database. RESULTS: During an 18-month FU period, a total of 70 RM transmissions have been received: one alert of high atrial burden triggering a pharmacological optimization, one alert of high ventricular impedance leading to a new ventricular lead implantation and four alerts of elective replacement indicator. Fulfilled questionnaires revealed complete patient satisfaction. CONCLUSIONS: A collaborative network between our hospital and the surrounding territory to perform RM FUs of CIEDs during Covid-19 pandemic was feasible, leading to patient compliance and satisfaction and revealing important technical and clinical alerts.

Remote blood pressure monitoring in high risk pregnancy - study protocol for a randomised controlled trial (REMOTE CONTROL trial).

BACKGROUND: Pregnant women at high risk for developing a hypertensive disorder of pregnancy require frequent antenatal assessments, especially of their blood pressure. This expends significant resources for both the patient and healthcare system. An alternative to in-clinic assessments is a remote blood pressure monitoring strategy, in which patients self-record their blood pressure at home using a validated blood pressure machine. This has the potential to be cost-effective, increase patient satisfaction, and reduce outpatient visits, and has had widespread uptake recently given the increased need for remote care during the ongoing COVID-19 pandemic. However robust evidence supporting this approach over a traditional face-to-face approach is lacking, and the impact on maternal and foetal outcomes has not yet been reported. Thus, there is an urgent need to assess the efficacy of remote monitoring in pregnant women at high risk of developing a hypertensive disorder of pregnancy. METHODS: The REMOTE CONTROL trial is a pragmatic, unblinded, randomised controlled trial, which aims to compare remote blood pressure monitoring in high-risk pregnant women with conventional face-to-face clinic monitoring, in a 1:1 allocation ratio. The study will recruit patients across 3 metropolitan Australian teaching hospitals and will evaluate the safety, cost-effectiveness, impact on healthcare utilisation and end-user satisfaction of remote blood pressure monitoring. DISCUSSION: Remote blood pressure monitoring is garnering interest worldwide and has been increasingly implemented following the COVID-19 pandemic. However, robust data regarding its safety for maternofoetal outcomes is lacking. The REMOTE CONTROL trial is amongst the first randomised controlled trials currently underway, powered to evaluate maternal and foetal outcomes. If proven to be as safe as conventional clinic monitoring, major potential benefits include reducing clinic visits, waiting times, travel costs, and improving delivery of care to vulnerable populations in rural and remote communities. TRIAL REGISTRATION: The trial has been prospectively registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12620001049965p, on October 11th, 2020).

Incidence of ventricular arrhythmias related to COVID infection and vaccination in patients with Brugada syndrome: Insights from a large Italian multicenter registry based on continuous rhythm monitoring.

INTRODUCTION: Brugada syndrome (BrS) has a dynamic ECG pattern that might be revealed by certain conditions such as fever. We evaluated the incidence and management of ventricular arrhythmias (VAs) related to COVID-19 infection and vaccination among BrS patients carriers of an implantable loop recorder (ILR) or implantable cardioverter-defibrillator (ICD) and followed by remote monitoring. METHODS: This was a multicenter retrospective study. Patients were carriers of devices with remote monitoring follow-up. We recorded VAs 6 months before COVID-19 infection or vaccination, during infection, at each vaccination, and up to 6-month post-COVID-19 or 1 month after the last vaccination. In ICD carriers, we documented any device intervention. RESULTS: We included 326 patients, 202 with an ICD and 124 with an ILR. One hundred and nine patients (33.4%) had COVID-19, 55% of whom developed fever. Hospitalization rate due to COVID-19 infection was 2.76%. After infection, we recorded only two ventricular tachycardias (VTs). After the first, second, and third vaccines, the incidence of non-sustained ventricular tachycardia (NSVT) was 1.5%, 2%, and 1%, respectively. The incidence of VT was 1% after the second dose. Six-month post-COVID-19 healing or 1 month after the last vaccine, we documented NSVT in 3.4%, VT in 0.5%, and ventricular fibrillation in 0.5% of patients. Overall, one patient received anti-tachycardia pacing and one a shock. ILR carriers had no VAs. No differences were found in VT before and after infection and before and after each vaccination. CONCLUSIONS: From this large multicenter study conducted in BrS patients, followed by remote monitoring, the overall incidence of sustained VAs after COVID-19 infection and vaccination is relatively low.

Pareto-Optimized AVQI Assessment of Dysphonia: A Clinical Trial Using Various Smartphones

Multiparametric indices offer a more comprehensive approach to voice quality assessment by taking into account multiple acoustic parameters. Artificial intelligence technology can be utilized in healthcare to evaluate data and optimize decision-making processes. Mobile devices provide new opportunities for remote speech monitoring, allowing the use of basic mobile devices as screening tools for the early identification and treatment of voice disorders. However, it is necessary to demonstrate equivalence between mobile device signals and gold standard microphone preamplifiers. Despite the increased use and availability of technology, there is still a lack of understanding of the impact of physiological, speech/language, and cultural factors on voice assessment. Challenges to research include accounting for organic speech-related covariables, such as differences in conversing voice sound pressure level (SPL) and fundamental frequency (f0), recognizing the link between sensory and experimental acoustic outcomes, and obtaining a large dataset to understand regular variation between and within voice-disordered individuals. Our study investigated the use of cellphones to estimate the Acoustic Voice Quality Index (AVQI) in a typical clinical setting using a Pareto-optimized approach in the signal processing path. We found that there was a strong correlation between AVQI results obtained from different smartphones and a studio microphone, with no significant differences in mean AVQI scores between different smartphones. The diagnostic accuracy of different smartphones was comparable to that of a professional microphone, with optimal AVQI cut-off values that can effectively distinguish between normal and pathological voice for each smartphone used in the study. All devices met the proposed 0.8 AUC threshold and demonstrated an acceptable Youden index value.

IoT and its Significance on Smart Technologies in the Health Sector-An Extensive Review

IoT seems to be the trending solution in all sectors notably because of the yield in productivity, efficiency, effective strategies, and results that are associated with adapting to this technology. These positive results are enormously experienced in one of the crucial sectors which determine and ensure the prolonged healthy life expectancy of mankind. It is well noted that a lot of work has been done on this topic in Academia and Corporate field all over the world but this paper will present a selective review that has been done so far by the Academic world as a scholarly article and a resource for the Health Sector in Fiji to earnestly integrate smart technologies in its architecture. © 2022 IEEE.

Novel student roles in health care delivery: An example emerging from the COVID-19 health care crisis in 2021.

In 2021, the rapid rise in COVID-19 infections put overwhelming demand on health care services. It was recognised that patients could be managed in the community if an appropriate monitoring service existed. Medical students were recruited for roles that combined technology, teamwork and clinical skills. This is an example of how novel roles can provide solutions in times of health care crises.

Cardiac implantable electronic devices replacements in patients followed by remote monitoring during COVID-19 lockdown.

Aims: Following coronavirus disease (COVID-19) outbreak, the Italian government adopted strict rules of lockdown and social distancing. The aim of our study was to assess the admission rate for cardiac implantable electronic devices (CIEDs) replacement procedures in Campania, the 3rd-most-populous region of Italy, during COVID-19 lockdown. Methods and results: Data were sourced from 16 referral hospitals in Campania from 10 March to 4 May 2020 (lockdown period) and during the same period in 2019. We retrospectively evaluated consecutive patients hospitalized for CIEDs replacement procedures during the two observational periods. The number and type of CIEDs replacement procedures among patients followed by remote monitoring (RM), the admission rate, and the type of hospital admission between the two observational periods were compared. In total, 270 consecutive patients were hospitalized for CIEDs replacement procedures over the two observation periods. Overall CIEDs replacement procedures showed a reduction rate of 41.2% during COVID-19 lockdown. Patients were equally distributed for sex (P = 0.581), and both age [median 76 years (IQR: 68-83) vs. 79 years (IQR: 68-83); P = 0.497]. Cardiac implantable electronic devices replacement procedures in patients followed by RM significantly increased (IR: +211%; P < 0.001), mainly driven by the remarkable increase rate trend of both PM (IR: +475%; P < 0.001) and implantable cardiac defibrillator replacement procedures (IR: +67%, P = 0.01), during COVID-19 lockdown compared with 2019 timeframe. Conclusions: We showed a significant increase trend rate of replacement procedures among CIEDs patients followed by RM, suggesting the hypothesis of its increased use to closely monitoring and to optimize the hospital admission time during COVID-19 lockdown.

Effectiveness and Medicoeconomic Evaluation of Home Monitoring of Patients With Mild COVID-19: Covidom Cohort Study.

BACKGROUND: Covidom was a telemonitoring solution for home monitoring of patients with mild to moderate COVID-19, deployed in March 2020 in the Greater Paris area in France to alleviate the burden on the health care system. The Covidom solution included a free mobile application with daily monitoring questionnaires and a regional control center to quickly handle patient alerts, including dispatching emergency medical services when necessary. OBJECTIVE: This study aimed to provide an overall evaluation of the Covidom solution 18 months after its inception in terms of effectiveness, safety, and cost. METHODS: Our primary outcome was to measure effectiveness using the number of handled alerts, response escalation, and patient-reported medical contacts outside of Covidom. Then, we analyzed the safety of Covidom by assessing its ability to detect clinical worsening, defined as hospitalization or death, and the number of patients with clinical worsening without any preceding alert. We evaluated the cost of Covidom and compared the cost of hospitalization for Covidom and non-Covidom patients with mild COVID-19 cases seen in the emergency departments of the largest network of hospitals in the Greater Paris area (Assistance Publique-Hôpitaux de Paris). Finally, we reported on user satisfaction. RESULTS: Of the 60,073 patients monitored by Covidom, the regional control center handled 285,496 alerts and dispatched emergency medical services 518 times. Of the 13,204 respondents who responded to either of the follow-up questionnaires, 65.8% (n=8690) reported having sought medical care outside the Covidom solution during their monitoring period. Of the 947 patients who experienced clinical worsening while adhering to daily monitoring, only 35 (3.7%) did not previously trigger alerts (35 were hospitalized, including 1 who died). The average cost of Covidom was €54 (US $1=€0.8614) per patient, and the cost of hospitalization for COVID-19 worsening was significantly lower in Covidom than in non-Covidom patients with mild COVID-19 cases seen in the emergency departments of Assistance Publique-Hôpitaux de Paris. The patients who responded to the satisfaction questionnaire had a median rating of 9 (out of 10) for the likelihood of recommending Covidom. CONCLUSIONS: Covidom may have contributed to alleviating the pressure on the health care system in the initial months of the pandemic, although its impact was lower than anticipated, with a substantial number of patients having consulted outside of Covidom. Covidom seems to be safe for home monitoring of patients with mild to moderate COVID-19.

Clinical Pathways Guided by Remotely Monitoring Cardiac Device Data: The Future of Device Heart Failure Management?

Research examining the utility of cardiac device data to manage patients with heart failure (HF) is rapidly evolving. COVID-19 has reignited interest in remote monitoring, with manufacturers each developing and testing new ways to detect acute HF episodes, risk stratify patients and support self-care. As standalone diagnostic tools, individual physiological metrics and algorithm-based systems have demonstrated utility in predicting future events, but the integration of remote monitoring data with existing clinical care pathways for device HF patients is not well described. This narrative review provides an overview of device-based HF diagnostics available to care providers in the UK, and describes the current state of play with regard to how these systems fit in with current HF management.

Review: Remote Disease Monitoring in Rheumatoid Arthritis

Rheumatoid arthritis (RA), the archetypal inflammatory arthritis, remains a complex and challenging disease to manage in spite of the abundance of new therapies in the last 20 years. The unpredictable relapsing/remitting nature of RA is at odds with the current prevailing system of scheduled follow-ups, leaving patients with RA to manage pain, flares, and medications between appointments, which may be of little value if occurring during a period of disease control. The rapid progress in the field of mobile health (mHealth) in the last 10 years has led to a proliferation of smartphone applications (apps) targeted at people with RA. Harnessing the power of smartphones to deliver remote monitoring for patients with RA has gone from an exciting possibility to an urgent necessity due to the COVID-19 pandemic. Apps developed solely by commercial providers have been found to be of limited utility in disease monitoring. However, multiple global institutions have developed mHealth technology to support remote monitoring of RA patients, utilizing asynchronous technology for patients to submit indicators of their disease activity, ranging from validated electronic patient-reported outcome measures, to innovative monitoring utilizing smartphone biosensors. This review discusses the current published evidence for mobile applications designed to facilitate remote monitoring of RA, the common barriers faced in implementing mhealth monitoring and strategies to overcome these, and potential areas for future research.

Telecommunication in the COVID-19 era: As an assessment tool for patients with dermatomyositis

Rheumatoid arthritis (RA), the archetypal inflammatory arthritis, remains a complex and challenging disease to manage in spite of the abundance of new therapies in the last 20 years. The unpredictable relapsing/remitting nature of RA is at odds with the current prevailing system of scheduled follow-ups, leaving patients with RA to manage pain, flares, and medications between appointments, which may be of little value if occurring during a period of disease control. The rapid progress in the field of mobile health (mHealth) in the last 10 years has led to a proliferation of smartphone applications (apps) targeted at people with RA. Harnessing the power of smartphones to deliver remote monitoring for patients with RA has gone from an exciting possibility to an urgent necessity due to the COVID-19 pandemic. Apps developed solely by commercial providers have been found to be of limited utility in disease monitoring. However, multiple global institutions have developed mHealth technology to support remote monitoring of RA patients, utilizing asynchronous technology for patients to submit indicators of their disease activity, ranging from validated electronic patient-reported outcome measures, to innovative monitoring utilizing smartphone biosensors. This review discusses the current published evidence for mobile applications designed to facilitate remote monitoring of RA, the common barriers faced in implementing mhealth monitoring and strategies to overcome these, and potential areas for future research.

Digital Health and Rheumatology: The Indian Context

India as a country of contrast and diversity has witnessed digital evolution in different waves and stages. The technology is already an integral part of lives of millions in India;however, its application in the health management remains limited unlike developed economies. COVID-19 pandemic has plunged the country into universal, regional, or local lockdowns repeatedly since the last year. An unexpected and unforeseen impact of this has been the usage of technology for doctor-patient interactions through telemedicine. Hitherto limited to certain pockets, virtual interactions with doctors, ordering laboratory investigations through an application or procuring medicines through internet, are now part of mainstream patient behavior. This is a crucial change in the mindset but requires a lot more to be done at various levels to tap its full potential with rheumatologists being at the forefront and leading the change in their specialty. The pool of rheumatologists is very small and mostly concentrated in few urban areas, leading to diagnostic delay, suboptimal treatment, and poor outcomes. Technology could, therefore, become a catalyst for change and harbinger for greater clinician access. There are plenty of discussions about the impact and potential of deep learning, artificial intelligence, remote monitoring with wearables, etc., but plenty of them may not be relevant to Indian patients in the current scenario. Hence, the context, relevance, and applicability are the key for rheumatologists when making a judgment.

FedCare: Federated Learning for Resource-Constrained Healthcare Devices in IoMT System

In social IoMT systems, resource-constrained devices face the challenges of limited computation, bandwidth, and privacy in the deployment of deep learning models. Federated learning (FL) is one of the solutions to user privacy and provides distributed training among several local devices. In addition, it reduces the computation and bandwidth of transferring videos to the central server in camera-based IoMT devices. In this work, we design an edge-based federated framework for such devices. In contrast to traditional methods that drop the resource-constrained stragglers in a federated round, our system provides a methodology to incorporate them. We propose a new phase in the FL algorithm, known as split learning. The stragglers train collaboratively with the nearest edge node using split learning. We test the implementation using heterogeneous computing devices that extract vital signs from videos. The results show a reduction of 3.6 h in the training time of videos using the split learning phase with respect to the traditional approach. We also evaluate the performance of the devices and system with key parameters, CPU utilization, memory consumption, and data rate. Furthermore, we achieve 87.29% and 60.26% test accuracy at the nonstragglers and stragglers, respectively, with a global accuracy of 90.32% at the server. Therefore, FedCare provides a straggler-resistant federated method for a heterogeneous system for social IoMT devices.