Non-invasive remote detection of cardiac and blood displacements is an important topic in cardiac telemedicine. Here we propose kinocardiography (KCG), a non-invasive technique based onmeasurement of body vibrations produced by myocardial contraction and blood flow through thecardiac chambers and major vessels. KCG is based on ballistocardiography and seismocardiographyand measures 12 degrees-of-freedom (DOF) of body motion. The integral of kinetic energy (iK)and maximum Power (Pmax) obtained from the linear and rotational SCG/BCG signals, was computedover the cardiac cycle, and used as a marker of cardiac mechanical function. We showedthat KCG metrics show high repeatability, can be computed on 50 Hz and 1 kHz SCG/BCG signalsindifferently, that most of the metrics were highly similar when computed on different sensors,and with less than 5% of error when computed on record length longer than 60 s. Finally, weshow that KCG metrics allow detecting dobutamine-induced haemodynamic changes with a highaccuracy and present a major improvement over single axis ballistocardiography or seismocardiography.These results suggest that KCG may be a robust and non-invasive method to monitorcardiac inotropic activity. / La détection à distance et non invasive des déplacements cardiaques et sanguins est un sujet important en télémédecine. Nous proposons ici la kinocardiographie (KCG), une technique non invasive basée sur mesure des vibrations corporelles produites par la contraction du myocarde et par le flux sanguin au travers des cavités cardiaques et des principaux vaisseaux sanguins. La KCG est basée sur la balistocardiographie et la seismocardiographie et mesure 12 degrés de liberté (DOF) de mouvement corporel. L'intégrale de l'énergie cinétique (iK) et la puissance maximale (Pmax) obtenue à partir des signaux SCG / BCG linéaire et rotationnel, a été calculée au cours du cycle cardiaque, et sont utilisées comme marqueur de la fonction mécanique cardiaque. Ce travail montre que les métriques KCG sont caractérisées par une répétabilité élevée, peuvent être calculées sur des signaux SCG / BCG à 50 Hz et à 1 kHz indifféremment, que la plupart des métriques étaient très similaires lorsqu'elles étaient calculées sur différents capteurs, et avec moins de 5% d'erreur lors du calcul sur une longueur d'enregistrement supérieure à 60 s. Enfin ce travail montre que les métriques KCG permettent de détecter les changements hémodynamiques induits par la dobutamine avec précision et présentent une amélioration majeure par rapport à la balistocardiographie à un seul axe ou à la seismocardiographie. Ces résultats suggèrent que la KCG peut être une méthode robuste et non invasive pour surveiller l'activité inotrope du coeur. / Doctorat en Sciences de l'ingénieur et technologie / La défense publique a eu lieu le 05/05/2021. Cet upload remplace l'upload pécédent et contient les derniers commentaires du jury après la défense publique. / info:eu-repo/semantics/nonPublished

Background: The use of telepharmacy has increased worldwide during the last decades, and facilitated by the COVID-19 pandemic, it will likely accelerate further. Sweden has several pre-conditions needed for telepharmacy, yet, telepharmacy development is slow. Aim: The present study's objective was to examine Swedish pharmacy students' views and opinions on telepharmacy in Sweden today and their education. A particular interest in communication education and whether it has prepared the students for patient communication at a distance. Additionally, the study explores e-pharmacy professionals views on the needed skills and experiences when working in the Swedish telepharmacy field. Methods: Two focus groups of fourth-year pharmacy students were performed in April 2021 via the web-based videoconference program Zoom. An open-ended questionnaire was sent via e-mail to practising e-pharmacy professionals. Five students and three e-pharmacy professionals participated in the study. Thematic inductive analysis was used to analyse the collected data. Results: The study's result implicates that the Swedish pharmacy education curriculum does not include telepharmacy. The students desire further education regarding communication at a distance but believe that part of the current education could be applied in an e-pharmacy setting.  The students' skepticism to e-pharmacies ability to perform safe and satisfactory pharmaceutical services is largely based on preconceptions and assumptions, partly confirmed by e-pharmacy professionals.  Conclusions: To not inhibit future developments in the pharmacy market, future pharmacists must be educated on telepharmacy methods. This study's insights may be useful for future educational initiatives and developments of the pharmacy education curriculum.

The purpose of this study was to gain a deeper understanding of the patient’s perspective regarding social interactions in video healthcare meetings. Social presence theory was used in the context of how video calls can result in vital aspects of social interactions disappearing and how that can affect the outcome of a doctor consultation in contrast to physical meetings. A qualitative method with semi-structured interviews was applied to this study. This study included 7 participants with similar age range from 26-36 years old including both genders. This study resulted in many different views and perspectives whereas some participants found it harder to communicate virtually whereas others did not think that social interactions was not even an important factor. The conclusion that could be made from this study is that virtual healthcare meetings are good depending on which context they are used for. Furthermore, the doctor cannot always get the full picture because the camera creates a psychological distance which makes it harder for the doctor to observe as much as he/she can in a physical setting which can lead to many signals and cues missing out.

Les nouvelles technologies de l'information et de la communication constituent des outils utiles pour améliorer le système de santé. Les décisions relatives à leur mise en œuvre ainsi qu'à leur utilisation doivent être basées sur des observations solides pour évaluer les impacts sur les soins et la santé. L'utilisation difficile des méthodes d'évaluation économique est due à la multidimensionnalité de l'évaluation des implémentations de télémédecine. En effet, pour évaluer l'impact de l'introduction de la télémédecine, il est nécessaire de prendre en compte les indicateurs divers identifiées dans la littérature. En outre, ils doivent être considérés par rapport à tous les acteurs impliqués dans le processus de décision. Dans ce contexte, l'aide multicritère à la décision peut fournir des informations supplémentaires sur l'évaluation de la télémédecine. L'objectif de cette thèse est de présenter une méthodologie d'évaluation multicritère impliquant de multiples décideurs pour la mise en place d'unité de dialyse médicalisée avec télémédecine (UDMT). Pour prendre une décision, le directeur de l'hôpital souhaite prendre en compte, à côté des indicateurs mentionnés ci-dessus, les préférences des médecins et des patients. Pour expliciter ces préférences, nous suggérons de considérer que les patients et les médecins sont des décideurs qui exprime un classement des différentes modalités de soins qui sont évaluées sur plusieurs critères. Nous sommes face à une situation impliquant plusieurs juges qui recouvrent une multiplicité de points de vue. Pour résoudre ce problème, nous utilisons des techniques à la fois de la théorie du choix social et de l'aide multicritère à la décision. D'abord, nous proposons d'agréger les classements individuels des patients sur les différentes modalités de soins, ce classement est ensuite utilisé dans la phase d'élicitation des préférences des médecins. Les classements individuels de ces derniers sont ensuite agrégées dans un classement des médecins qui est ensuite combiné avec celui de patients et d'autres critères économiques pour déterminer les préférences du directeur d'hôpital sur les modalités de soins. Cette méthodologie est appliquée à la mise en œuvre d'unités de dialyse médicalisées en Bretagne, sur la base des préférences de patients, médecins et directeur de l'hôpital. Les préférences de tous les acteurs de ce processus de décision sont représentables par des modèles d'utilité additives. L'alternative préférée parmi les patients et les médecins est l'UDMT. Le critère qui a le plus d'impact sur la décision des patients (resp. Les médecins) est la distance de l'unité de dialyse (resp. La satisfaction des patients). Enfin, l'analyse montre que les critères les plus importants pour le directeur de l'hôpital sont la satisfaction des médecins et des patients. Ce travail montre qu'il est important de tenir compte de l'hétérogénéité et de la multiplicité des points de vue et des acteurs dans l'évaluation. / The new information and communication technologies represent useful tools for improving the health system. Decisions on their implementation and use must be based on solid observations to assess their impacts on care and health. The difficult use of classical economic evaluation methods is due to the multidimensionality of the assessment of telemedicine implementations. Indeed, to evaluate the impact of the introduction of telemedicine, it is necessary to take into account various indicators identified in the literature, as cost, accessibility, acceptability and quality. Furthermore, they need to be considered with respect to all the stakeholders involved in the decision process. In this context, decision support theories provide additional insight into the evaluation of telemedicine. The objective of this thesis is to present a multicriteria evaluation methodology involving multiple decision makers for the establishment of remotely monitored medical dialysis (RMMD) solutions. To reach a decision, the hospital director wishes to take into account, next to the above mentionned indicators, the preferences of the physicians and the dialysis patients. In order to explicit these preferences, we suggest to consider that the patients and the physicians are decision makers which have to express a ranking of care modalities evaluated on multiple criteria. We thus face a situation involving multiple judges which overlay a multiplicity of viewpoints. To solve this problem, we use techniques both from social choice theory and multicriteria decision analysis. First we propose to agregate the individual rankings of the patients on the potential multicriteria care modalities into a patient-wide order, which is then used in the multicriteria preference elicitation phasis of the physicians. The individual rankings of the latter ones is then aggregated into a physician-wide ranking which is then combined with the patients' one and further economical criteria to elicit the hospital director's preferences on the care modalities. This methodology is applied to the implementation of medical dialysis units in Brittany (France), on basis of the preferences of 16 patients, 8 physicians and 1 hospital director. The preferences of all the stakeholders of this decision process are representable by additive value models. The preferred alternative among the patients and the physicians is the medical dialysis unit with remote monitoring. The criterion which has the highest impact on the patients' (resp. physicians') decision is the distance to the dialysis unit (resp. the patients' satisfaction). Finally, the analysis shows that the most important criteria for the hospital director are the physicians' and the patients' satisfaction. This work shows that it is important to consider the heterogeneity and the multiplicity of viewpoints and actors in the evaluation of the implementation of RMMD solutions via multicriteria decision support techniques.

The development of telemedicine in the context of cross-border healthcare services in the European Union: comparative approach France / Czech Republic The role of the European Union, within the context of its support in the field of public health, consists of helping the Member States to achieve the goals defined in the multiannual framework program. Among these goals, telemedicine is a priority of eHealth. Telemedicine is a form of healthcare provided remotely using Information and Communication Technology (ICT). It aims to improve the efficiency of medical care systems faced with the ageing of the European population. This thesis is a study of cross-border telemedicine in the context of cross-border medical care as it is regulated by European Union law. However, the deployment of cross-border telemedicine depends on the competence of the Member States. A comparison between French and Czech legislation, in terms of the implementation of telemedicine in these Member States, reveals different strategies regarding the integration of telemedicine into their healthcare systems. In light of these two significant examples, it will be possible to show how the deployment of telemedicine in domestic law influences its cross-border development. European legislation encourages states to use cross-border...

Telemedicine extends medical services to patients in remote areas. Due to the trend of population ageing, telemedicine becomes more and more popular. The Internet provides great opportunity for transmitting medical data. However the Internet is unreliable, some uncontrollable network behaviors (such as packet loss, packet delay) influence the quality of medical services greatly. Additionally,most existing medical data formats are designed for storing medical records not for streaming medical data over an unreliable medium. In order to promote the efficiency and achieve the error control of medical sensor data streaming service, this project aims to 1) investigate different streaming protocols and encoding strategies;2) empirically evaluate these encoding strategies and find an optimum choice.In this project, we focus on a home-based electrocardiograph(ECG) sensor monitoring service which requires little overhead, low latency and constant data rate. We develop a framework for testing the efficiency of medical streaming service, and empirically evaluate four forward error correction (FEC) encoding strategies with different erasure codes (XORcod,RS code) and block interleavers. The performances of the four encoding strategies are measured by calculating the Repair Rate &Peak Signal Noise Ratio (PSNR), and the processing times of these encoders are measured as well. Network simulation is used to establish the unreliable network and Network Simulator3 (NS3) is employed as the simulation tool. From the simulation results,we come up the conclusions: Firstly, the average burst error length of a network is the key factor which influences the performance comparison of the four encoding strategies.Secondly, interleaving provides positive impact when packet losses are bursty; while it results in negative impact when packet losses are scattered.Based on the conclusions above, FEC-XOR-Interleaving encoding strategy is the optimum choice for the home-based ECG sensor monitoring scenario,

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Durante la pandemia COVID-19 se ha incrementado el uso de la telemedicina y de plataformas virtuales en el campo de la medicina, por ello en nuestra institución contamos con un sistema multicámara que permite la visualización en vivo de procedimientos endovasculares. Se realizaron once casos de aneurismas, malformaciones arteriovenosas y hematomas subdurales crónicos que fueron tratados y transmitidos en vivo sin problemas técnicos a través de la plataforma Zoom®. El tiempo promedio de transmisión y del número de participantes fue de 2.5 horas y 6 participantes, respectivamente. En todos los casos se discutió la técnica empleada y las complicaciones ocurridas. El aprendizaje remoto con plataformas en línea es hoy en día una herramienta importante, pero no un sustituto del aprendizaje práctico para procedimientos endovasculares. Recomendamos su implementación durante la pandemia de COVID-19 como un sustituto temporal, especialmente para los médicos en entrenamiento que no tienen acceso a intervenciones endovasculares avanzadas.

Bakgrund  Hjärtsvikt är en folksjukdom som orsakar lidande hos de drabbade och medför dessutom ett stort ansvar för den egna hälsan. Egenvård är för personer med hjärtsvikt en viktig del för att förhindra försämringar då snabba förändringar av sjukdomstillståndet kan ske. Om den drabbade saknar den motivation eller kunskap som krävs kan det följaktligen medföra komplikationer. Sjuksköterskan har därför ett stort ansvar att utbilda och stödja den drabbade för att förhindra detta. E-hälsa kan därför vara ett bra stöd för att underlätta både för den drabbade och sjuksköterskan.  Syfte  Syftet med arbetet var att kartlägga förväntningar och upplevelser på E-hälsa som stöd till egenvård, hos personer med hjärtsvikt.  Metod  För att besvara syftet genomfördes en icke-systematisk litteraturöversikt som baserades på 15 vetenskapliga artiklar. Både kvalitativa och kvantitativa artiklar inkluderades. Artiklarna inhämtades med hjälp av relevanta sökord i databaserna PubMed och CINAHL. För att säkerställa att artiklarna var av god kvalitet användes Sophiahemmet Högskolas bedömningsunderlag, vidare utfördes en integrerad analys där två huvudkategorier och sju subkategorier identifierades.  Resultat  Resultatet delades in i förväntningar av kommunikation och förståelsesamt upplevelser av påverkad sjukdomsförståelse som huvudkategorier. I resultatet framkom det att patienter med hjärtsvikt förväntade sig en förbättrad vårdrelation, förbättrad egenvård och ökad förståelse för sin sjukdom. Vidare upplevde patienterna ökade kunskaper om egenvård vid hjärtsvikt vilket medförde förbättrad egenvård. Dessutom upplevdes en förbättrad kontakt med sjukvårdspersonal och ökad motivation till att fortsätta med goda rutiner. Problem med tekniken var en vanlig komplikation.  Slutsats  I den aktuella litteraturöversikten framkom det att många ansåg E-hälsotjänster som ett bra stöd till egenvård då de fick en ökad förståelse för sin sjukdom. Fynden anses därför vara ett stöd för att finna egenvårdsbalans. Vidare forskning av ämnet anses dock vara nödvändigt för att resultatet ska kunna betraktas som överförbart. / Background  Heart failure is a widespread disease that causes suffering for those who are affected and brings a great deal of responsibility of their own health. Self-care plays a crucial part in preventing deterioration for people with heart failure, since rapid changes of the medical condition can occur. If the affected lacks the required motivation or knowledge, it can consequently lead to complications. Therefore, the nurse has a great deal of responsibility to educate and aid the affected to prevent this. E-health is for that reason believed to be a good support to facilitate for both the affected and the nurse.  Aim  The aim was to describe expectations and experiences of E-health as a support for self- care, among people with heart failure.  Method  A non-systematic literature review based on 15 scientific articles was made to answer the purpose. Both qualitative and quantitative articles were included. The articles were collected using relevant keywords in the data bases PubMed and CINAHL. To ensure that the articles were of good quality, the assessment basis of Sophiahemmet University were used. Furthermore, an integrated analysis was performed where two main categories and seven subcategories were identified.  Results  The result was divided into the two main categories expectations of communication and understanding and experiences of affected understanding of the disease. It emerged in the result that patients with heart failure expected improved care relationship, improved self- care and improved understanding of one’s disease were expected. Furthermore, increased knowledge about self-care in heart failure was experienced, which led to improved self- care. Additionally, there was an improved contact with healthcare staff and an increased motivation to proceed with good practices. The most common complication were problems with the E-health technology.  Conclusions  The current literature review emerged that many considered E-health as a good support for self-care as they gained an increased understanding of one’s disease. The findings are therefore considered to be a support to find self-care balance. However, further research of the subject is considered necessary for the result to be considered transferable.

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