MYeHealthAppCY: A Healthcare Mobile Application in Cyprus.

This paper presents MYeHealthAppCY, an mHealth solution designed to provide patients and healthcare providers in Cyprus with access to medical data. The application includes features such as an at-a-glance view of patient summary, comprehensive prescription management, teleconsultation, and the ability to store and access European Digital COVID Certificates (EUDCC). The application is an integral part of the eHealth4U platform targeting to implement a prototype EHR platform for national use. The application developed is based on FHIR and follows a strict adherence to widely used coding standards. The application was evaluated receiving satisfactory scores; however, significant work is still needed to deploy the application in production.

eHealth4U: A DEMO of a Prototype National Electronic Health Record for Cyprus.

In this paper we present a demonstration of a prototype national Electronic Health Record platform for Cyprus. This prototype is developed using the HL7 FHIR interoperability standard in combination with terminologies widely adopted by the clinical community such as the SNOMED CT and the LOINC. The system is organized in such a way to be user-friendly for its users, being the doctors and the citizens. The health-related data of this EHR are separated into three main sections, being the "Medical History", the "Clinical Examination" and the "Laboratory results". Business requirements include the Patient Summary as defined by the guidelines of the eHealth network and the International Patient Summary which are used as the base for all the sections of our EHR, together with additional medical information and functionality such as the organization of medical teams or the history of medical visits and episodes of care. From the doctor's point of view, one can search for patients who have granted the doctor with a consent and read or add/edit their EHR data by initiating a new visit as defined in the Cyprus National Law for eHealth. At the same time, doctors can organize their medical teams by managing the locations of each team and the members that belong to each team.

A Scoping Review of Methods Used to Assess Medication Adherence in Patients with Chronic Conditions.

BACKGROUND: Medication nonadherence of patients with chronic conditions is a complex phenomenon contributing to increased economic burden and decreased quality of life. Intervention development relies on accurately assessing adherence but no "gold standard" method currently exists. PURPOSE: The present scoping review aimed to: (a) review and describe current methods of assessing medication adherence (MA) in patients with chronic conditions with the highest nonadherence rates (asthma, cancer, diabetes, epilepsy, HIV/AIDS, hypertension), (b) outline and compare the evidence on the quality indicators between assessment methods (e.g., sensitivity), and (c) provide evidence-based recommendations. METHODS: PubMed, PsycINFO and Scopus databases were screened, resulting in 62,592 studies of which 71 met criteria and were included. RESULTS: Twenty-seven self-report and 10 nonself-report measures were identified. The Medication Adherence Report Scale (MARS-5) was found to be the most accurate self-report, whereas electronic monitoring devices such as Medication Event Monitoring System (MEMS) corresponded to the most accurate nonself-report. Higher MA rates were reported when assessed using self-reports compared to nonself-reports, except from pill counts. CONCLUSIONS: Professionals are advised to use a combination of self-report (like MARS-5) and nonself-report measures (like MEMS) as these were found to be the most accurate and reliable measures. This is the first review examining self and nonself-report methods for MA, across chronic conditions with the highest nonadherence rates and provides evidence-based recommendations. It highlights that MA assessment methods are understudied in certain conditions, like epilepsy. Before selecting a MA measure, professionals are advised to inspect its quality indicators. Feasibility of measures should be explored in future studies as there is presently a lack of evidence.

A Prototype of the National EHR system for Cyprus.

The aim of this paper is to present Cyprus' initiative for the design and the implementation of the prototype of the integrated electronic health record at a national level that will establish the foundations of the country's broader eHealth ecosystem. The latter, requires an interdisciplinary approach and scientific collaboration among various fields, including medicine, information and communication technologies, management, and finance, among others. The objective, is to design the system architecture, specify the requirements in terms of clinical content as well as the hardware infrastructure, but also implement European and national legislation with respect to privacy and security that govern sensitive medical data manipulation. The present study summarizes the outcomes of the 1st phase of this initiative, which comprises of the healthcare as well as the administrative requirements, user stories, data-flows and associated functionality. Moreover, leveraging the HL7 Fast Healthcare Interoperability Resources (FHIR) standard we highlight the concluded interoperability framework that allows genuine cross-system communication and defines third-party systems connectivity.Clinical Relevance- This work is strongly correlated with medicine since it describes the system requirements and the architecture of a national integrated electronic health records system.

Barriers, facilitators, and interventions for medication adherence across chronic conditions with the highest non-adherence rates: a scoping review with recommendations for intervention development.

Medication non-adherence (MNA) constitutes a complex health problem contributing to increased economic burden and poor health outcomes. The Medication Adherence Model (MAM) supports that numerous processes are involved in medication adherence (MA). Based on the MAM and guidelines of the World Health Organization (WHO), this scoping review aimed to identify the barriers and facilitators associated with MA, and the behavioral health interventions and techniques among chronic conditions presenting with high non-adherence rates (asthma, cancer, diabetes, epilepsy, HIV/AIDS, and hypertension). PubMed, PsycINFO, and Scopus databases were screened, and 243 studies were included. A mixed methods approach was used to collate the evidence and interpret findings. The most commonly reported barriers to MA across conditions were younger age, low education, low income, high medication cost, side effects, patient beliefs/perceptions, comorbidities, and poor patient-provider communication. Additionally, digitally delivered interventions including components such as medication and condition education, motivational interviewing (MI), and reinforcement and motivational messages led to improvements in MA. This review highlights the importance of administrating multicomponent interventions digitally and personalized to the patients' individual needs and characteristics, responding to the adherence barriers faced. This is the first review examining and synthesizing evidence on barriers and facilitators to MA and behavioral health interventions used for improving MA across chronic conditions with the highest non-adherence rates and providing recommendations to researchers and clinicians. Stakeholders are called to explore methods overcoming barriers identified and developing effective multicomponent interventions that can reduce the high rates of MNA.

AI in Medical Imaging Informatics: Current Challenges and Future Directions.

This paper reviews state-of-the-art research solutions across the spectrum of medical imaging informatics, discusses clinical translation, and provides future directions for advancing clinical practice. More specifically, it summarizes advances in medical imaging acquisition technologies for different modalities, highlighting the necessity for efficient medical data management strategies in the context of AI in big healthcare data analytics. It then provides a synopsis of contemporary and emerging algorithmic methods for disease classification and organ/ tissue segmentation, focusing on AI and deep learning architectures that have already become the de facto approach. The clinical benefits of in-silico modelling advances linked with evolving 3D reconstruction and visualization applications are further documented. Concluding, integrative analytics approaches driven by associate research branches highlighted in this study promise to revolutionize imaging informatics as known today across the healthcare continuum for both radiology and digital pathology applications. The latter, is projected to enable informed, more accurate diagnosis, timely prognosis, and effective treatment planning, underpinning precision medicine.

Risk factors for breast cancer brain metastases: a systematic review.

BACKGROUND: Brain metastasis (BM) is an increasingly common and devastating complication of breast cancer (BC). METHODS: A systematic literature search of EMBASE and MEDLINE was conducted to elucidate the current state of knowledge on known and novel prognostic factors associated with 1) the risk for BCBM and 2) the time to brain metastases (TTBM). RESULTS: A total of 96 studies involving institutional records from 28 countries were identified. Of these, 69 studies reported risk factors of BCBM, 46 factors associated with the TTBM and twenty studies examined variables for both outcomes. Young age, estrogen receptor negativity (ER-), overexpression of human epidermal factor (HER2+), and higher presenting stage, histological grade, tumor size, Ki67 labeling index and nodal involvement were consistently found to be independent risk factors of BCBM. Of these, triple-negative BC (TNBC) subtype, ER-, higher presenting histological grade, tumor size, and nodal involvement were also reported to associate with shorter TTBM. In contrast, young age, hormone receptor negative (HR-) status, higher presenting stage, nodal involvement and development of liver metastasis were the most important risk factors for BM in HER2-positive patients. CONCLUSIONS: The study provides a comprehensive and individual evaluation of the risk factors that could support the design of screening tools and interventional trials for early detection of BCBM.

The Upcoming Role for Nursing and Assistive Robotics: Opportunities and Challenges Ahead.

As an integral part of patient care, nursing is required to constantly adapt to changes in the healthcare system, as well as the wider financial and societal environment. Among the key factors driving these changes is the aging of population. Combined with an existing shortage of nursing and caregiving professionals, accommodating for the patients and elderly needs within hospitals, elderly-care facilities and at a home setting, becomes a societal challenge. Amongst the technological solutions that have evolved in response to these developments, nursing and assistive robotics claim a pivotal role. The objective of the present study is to provide an overview of today's landscape in nursing and assistive robotics, highlighting the benefits associated with adopting such solutions in standard clinical practice. At the same time, to identify existing challenges and limitations that essentially outline the area's future directions. Beyond technological innovation, the manuscript also investigates the end-users' angle, being a crucial parameter in the success of robotics solutions operating within a healthcare environment. In this direction, the results of a survey designed to capture the nursing professionals' perspective toward more informed robotics design and development are presented.

Radiogenomics for Precision Medicine With a Big Data Analytics Perspective.

Precision medicine promises better healthcare delivery by improving clinical practice. Using evidence-based substratification of patients, the objective is to achieve better prognosis, diagnosis, and treatment that will transform existing clinical pathways toward optimizing care for the specific needs of each patient. The wealth of today's healthcare data, often characterized as big data, provides invaluable resources toward new knowledge discovery that has the potential to advance precision medicine. The latter requires interdisciplinary efforts that will capitalize the information, know-how, and medical data of newly formed groups fusing different backgrounds and expertise. The objective of this paper is to provide insights with respect to the state-of-the-art research in precision medicine. More specifically, our goal is to highlight the fundamental challenges in emerging fields of radiomics and radiogenomics by reviewing the case studies of Cancer and Alzheimer's disease, describe the computational challenges from a big data analytics perspective, and discuss standardization and open data initiatives that will facilitate the adoption of precision medicine methods and practices.

Combined study on clastogenic, aneugenic and apoptotic properties of doxorubicin in human cells in vitro.

BACKGROUND: Doxorubicin is a widely used anticancer drug due to its broad spectrum of antitumor activity. Various mechanisms have been proposed for its cytostatic activity, including DNA intercalation, topoisomerase II inhibition, generation of free radicals and apoptosis. The present study aims to further clarify the cytostatic activity of doxorubicin by its specific effect on (a) DNA damage, (b) micronucleation and (c) apoptosis, using a combination of different methods and cell systems such as human lymphocytes and HL-60 human leukemic cells. DNA lesions were analyzed by the alkaline comet assay in combination with formamidopyrimidine (Fpg) and human 8-oxoguanine (hOGG1) repair enzymes. Micronucleation was investigated by the Cytokinesis-Block Micronucleus assay (CBMN) in combination with Fluorescence In Situ Hybridization analysis. Impairment on mitotic apparatus was investigated by double immunofluorescence of ß- and γ-tubulin. Apoptotic cell frequency was determined by the CBMN cytome assay. Complementary to the above, caspase-3 level was investigated by Western blot. RESULTS: It was found that doxorubicin generates DNA breakage induced by oxidative damage in DNA bases, which can be repaired by the Fpg and hOGG1 enzymes. Increased micronucleus frequency was identified mainly through chromosome breakage and, at a lesser extent, through chromosome delay. Analysis of mitotic spindle showed disturbance of chromosome orientation and centrosome duplication and/or separation, leading to aneuploidy. Enhanced frequency of apoptotic leukemic cells was also observed. Caspase-3 seems to be involved in the generation of apoptosis. CONCLUSIONS: The aforementioned findings derived from different treatment schedules, doses and time of exposure on primary versus transformed cells extend our knowledge about doxorubicin genotoxicity and contribute to the better understanding of the mechanisms by which doxorubicin induces genotoxic effects on human cells.

Real-Time Adaptation to Time-Varying Constraints for Medical Video Communications.

The wider adoption of mobile Health video communication systems in standard clinical practice requires real-time control to provide for adequate levels of clinical video quality to support reliable diagnosis. The latter can only be achieved with real-time adaptation to time-varying wireless networks' state to guarantee clinically acceptable performance throughout the streaming session, while conforming to device capabilities for supporting real-time encoding. We propose an adaptive video encoding framework based on multi-objective optimization that jointly maximizes the encoded video's quality and encoding rate (in frames per second) while minimizing bitrate demands. For this purpose, we construct a dense encoding space and use linear regression to estimate forward prediction models for quality, bitrate, and computational complexity. The prediction models are then used in an adaptive control framework that can fine-tune video encoding based on real-time constraints. We validate the system using a leave-one-out algorithm applied to ten ultrasound videos of the common carotid artery. The prediction models can estimate structural similarity quality with a median accuracy error of less than 1%, bitrate demands with deviation error of 10% or less, and encoding frame rate within a 6% margin. Real-time adaptation at a group of pictures level is demonstrated using the high efficiency video coding standard. The effectiveness of the proposed framework compared to static, nonadaptive approaches is demonstrated for different modes of operation, achieving significant quality gains, bitrate demands reductions, and performance improvements, in real-life scenarios imposing time-varying constraints. Our approach is generic and should be applicable to other medical video modalities with different applications.

Cardiac ultrasonography over 4G wireless networks using a tele-operated robot.

This Letter proposes an end-to-end mobile tele-echography platform using a portable robot for remote cardiac ultrasonography. Performance evaluation investigates the capacity of long-term evolution (LTE) wireless networks to facilitate responsive robot tele-manipulation and real-time ultrasound video streaming that qualifies for clinical practice. Within this context, a thorough video coding standards comparison for cardiac ultrasound applications is performed, using a data set of ten ultrasound videos. Both objective and subjective (clinical) video quality assessment demonstrate that H.264/AVC and high efficiency video coding standards can achieve diagnostically-lossless video quality at bitrates well within the LTE supported data rates. Most importantly, reduced latencies experienced throughout the live tele-echography sessions allow the medical expert to remotely operate the robot in a responsive manner, using the wirelessly communicated cardiac ultrasound video to reach a diagnosis. Based on preliminary results documented in this Letter, the proposed robotised tele-echography platform can provide for reliable, remote diagnosis, achieving comparable quality of experience levels with in-hospital ultrasound examinations.

Medical telerobotic systems: current status and future trends.

Teleoperated medical robotic systems allow procedures such as surgeries, treatments, and diagnoses to be conducted across short or long distances while utilizing wired and/or wireless communication networks. This study presents a systematic review of the relevant literature between the years 2004 and 2015, focusing on medical teleoperated robotic systems which have witnessed tremendous growth over the examined period. A thorough insight of telerobotics systems discussing design concepts, enabling technologies (namely robotic manipulation, telecommunications, and vision systems), and potential applications in clinical practice is provided, while existing limitations and future trends are also highlighted. A representative paradigm of the short-distance case is the da Vinci Surgical System which is described in order to highlight relevant issues. The long-distance telerobotics concept is exemplified through a case study on diagnostic ultrasound scanning. Moreover, the present review provides a classification into short- and long-distance telerobotic systems, depending on the distance from which they are operated. Telerobotic systems are further categorized with respect to their application field. For the reviewed systems are also examined their engineering characteristics and the employed robotics technology. The current status of the field, its significance, the potential, as well as the challenges that lie ahead are thoroughly discussed.

An effective ultrasound video communication system using despeckle filtering and HEVC.

The recent emergence of the high-efficiency video coding (HEVC) standard promises to deliver significant bitrate savings over current and prior video compression standards, while also supporting higher resolutions that can meet the clinical acquisition spatiotemporal settings. The effective application of HEVC to medical ultrasound necessitates a careful evaluation of strict clinical criteria that guarantee that clinical quality will not be sacrificed in the compression process. Furthermore, the potential use of despeckle filtering prior to compression provides for the possibility of significant additional bitrate savings that have not been previously considered. This paper provides a thorough comparison of the use of MPEG-2, H.263, MPEG-4, H.264/AVC, and HEVC for compressing atherosclerotic plaque ultrasound videos. For the comparisons, we use both subjective and objective criteria based on plaque structure and motion. For comparable clinical video quality, experimental evaluation on ten videos demonstrates that HEVC reduces bitrate requirements by as much as 33.2% compared to H.264/AVC and up to 71% compared to MPEG-2. The use of despeckle filtering prior to compression is also investigated as a method that can reduce bitrate requirements through the removal of higher frequency components without sacrificing clinical quality. Based on the use of three despeckle filtering methods with both H.264/AVC and HEVC, we find that prior filtering can yield additional significant bitrate savings. The best performing despeckle filter (DsFlsmv) achieves bitrate savings of 43.6% and 39.2% compared to standard nonfiltered HEVC and H.264/AVC encoding, respectively.

High-resolution, low-delay, and error-resilient medical ultrasound video communication using H.264/AVC over mobile WiMAX networks.

In this study, we describe an effective video communication framework for the wireless transmission of H.264/AVC medical ultrasound video over mobile WiMAX networks. Medical ultrasound video is encoded using diagnostically-driven, error resilient encoding, where quantization levels are varied as a function of the diagnostic significance of each image region. We demonstrate how our proposed system allows for the transmission of high-resolution clinical video that is encoded at the clinical acquisition resolution and can then be decoded with low-delay. To validate performance, we perform OPNET simulations of mobile WiMAX Medium Access Control (MAC) and Physical (PHY) layers characteristics that include service prioritization classes, different modulation and coding schemes, fading channels conditions, and mobility. We encode the medical ultrasound videos at the 4CIF (704 × 576) resolution that can accommodate clinical acquisition that is typically performed at lower resolutions. Video quality assessment is based on both clinical (subjective) and objective evaluations.