Using Smart Devices for Monitoring Elderly Patients in Rural Areas of Calabria after COVID-19 Vaccination: Experiences within the SI4CARE Project
, Margherita Menon 3, Filomena Talarico 1, Stella Fragkiadaki 4, Dionysia Kontaxopolou 4, Katarina Vukojevic 5, Danira Matijaca 5, Miodrag Miljkovic 6, Srdjan Kožetinac 6, Alessio Merola 2, Vlado Dimovski 7, Anamarija Kejar 7, Ivan Radevic 8, Danica Stevovic 9, Vlatka Martinovic 10, Katjia Matesan 11, Roberta Matkovic 11, Guido Piccoli 3, Francesco Esposito 12, Darja Semrov 15, Pietro Hiram Guzzi 2,16,* and add
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Round 1
Reviewer 1 Report
The Paper discusses some applications of an international telemedicine project in rural areas of the Adriatic Ionian regions. The problem is relevant because demographic projections demonstrate an increase in older people in the following years. In particular, this Paper describes the introduction of wearable devices for monitoring patients after vaccinations. The main ideas are sound, and the application scenario is relevant. The article may foster discussion and may be used to develop a novel policy of healthcare administration in rural areas.
Minor comments:
Please check carefully the paper beucause there are a few typos and misspellings.
Please give some more details on the database's dimension and provide some more cybersecurity information.
Please consider mentioning, even briefly, and referencing any recent bibliography item about topology-aware optimization strategies for minimizing virus spreading.
Author Response
To COVID
Editor in Chief
From Pietro Hiram Guzzi, on the behalf of all the authors.
Object: Manuscript updates for reviewer’s answer
Dear Editor,
First of all let us thank the anonymous reviewers for the observations on the manuscript. We went through the observations and we updated the manuscript as detailed below. We kindly ask you to consider the revised version and we hope that it may be considered for further revision. The proposed updates according to reviewer’s observations are highlighted in bold throughout the manuscript.
Moreover, we tried to answer to reviewers, proposing the following answers.
Looking forward to hearing from you,
best regards
Pietro Hiram Guzzi, on behalf of the authors.
Response to reviewers observations.
Reviewer 1
Reviewer Please check carefully the paper because there are a few typos and misspellings.
Answer: We checked the paper with the help of a native english speaker.
Reviewer: Please give some more details on the database's dimension and provide some more cybersecurity information.
Answer: We provided such information on the manuscript.
Reviewer: Please consider mentioning, even briefly, and referencing any recent bibliography item about topology-aware optimization strategies for minimizing virus spreading.
Answer: We thank you for this observation. We added these references.
Reviewer 2
The content is very interesting.
Answer: We thank the reviewer for the appreciation.
However, I would suggest some possible improvements left to the parties (authors and editor). These additions would be aimed at:
- Emphasize the importance of a collaborative project of these characteristics:
o Diverse nations in collaboration
o Diverse public administrations
o Different professional orientations: Neurologists, Administrators, Information experts, Technologists...
Answer: We added such information on the manuscript.
The transnational cooperation among diverse public administrations and different professional orientations is the key aspect of the SI4CARE project, since all the partners share the priority interest of the innovation of healthcare services for the elderly population through the application and combination of tools, procedures, actors and stakeholders. The rationale of the integration is that regional and local best practices in Social Innovation for healthcare service improvement do exist, but are often circumscribed to single cases, isolated and lack penetration into regional and national policies,. Consequently the need for an effort of cooperation and integration arises. Therefore the transnational and interdisciplinary approach is needed to share experiences, to scout for best practices and to effectively solution achieving real innovation and replicability. Finally, the personalized medicine approach is dependent from the availability of data at transnational level and standard for collecting them.
Reviewer I don't know where it fits to address these issues, but they should be specified somewhere. If not in this paper, then in some other future paper:
o Type of health systems (especially the structure of care services).
o Different socioeconomic situations
o Rates of Aging (specify data)
o Cultural aspects and current extent of the use of technologies
Answer: We thank the reviewer for the observation. All these data have been collected and reported in the Status Quo section of the project. We plan to discuss them in a review paper focused on the demographic and socio economic aspects.·
Evaluation:
o What type of evaluation will be done?
o On what aspects?
o With what instruments?
Answer: we plan to do a dual kind of evaluation. First a medical evaluation of the results in terms of the ability of the system to predict possible adverse events. We plan to learn a deep neural network based on a LSTM architecture that is able to predict adverse events, or simply events that should be reported, on the basis of the time series analysis. Furthermore, in relation with the aims of the project, we plan to demonstrate the effectiveness of the system in terms of well being of the patients and in the improvement of the healthcare system in term of the monitoring of patients.
Reviewer: In conclusion, the Brief Report is a very good start to the work of presenting the project and, in my opinion, it would be useful to have an introduction explaining the region, the importance of the collaboration, the reality of aging, the health system and the evaluation of the project that we propose to carry out. In my opinion it would improve with the incorporation of some of the suggestions I make to the authors.
We thank you for your attention, we added some of the suggestions in the paper.
Reviewer 3:
Reviewer:. As a general drawback, I could say that there is no reference to similar works that used wearables and deep learning methods (e.g. [1], [2]) in different health monitoring areas:
[1] Daskalos A-C, Theodoropoulos P, Spandonidis C, Vordos N. Wearable Device for Observation of Physical Activity with the Purpose of Patient Monitoring Due to COVID-19. Signals. 2022; 3(1):11-28.
[2] Viciano-Tudela, S., Sendra, S., Lloret, J., Tomas, J., & Belda-Ramirez, J. (2022). Development of a Low-Cost Pulse Oximeter for Taking Medical-Scientific Parameters to Monitor Remote Patients. Electronics, 11(19), 3061.
Answer: We apologize for missing such important information, we added these references.
Reviewer 2. More or less all fundamental theory details that are needed are discussed and a review of the problem under evaluation is sufficient. It would be beneficial to clarify the reasoning and the behind the selection of the methods.
Answer: We apologize for the lack of clarity, we added a discussion of the selection of the methods in the manuscript. We should note that the selection of the wearable devices, among the available ones, has been determined by the Calabria Region rules. The device we selected is currently the one certified by the Calabria region, so considering a possible future application in the real healthcare scenario we have to fulfill all the requirements of the Calabria Region,
Reviewer: 3. In addition, the authors could clarify the novelty and impact of their work. The work resembles an early-stage conference paper rather than a research article.
Answer: We added a section at the end of the introduction discussing novelty and impact of the work.
Reviewer: 4. In the same direction, authors should enhance the results section which is limited to a small paragraph.
Answer: we restructured the results section by adding more contents.
Author Response File: 
Author Response.docx
Reviewer 2 Report
Dear Authors,
Congratulations for your work. This is an interesting Brief Report that starts a series of papers on the implementation of telemonitoring systems for elderly people with health problems, especially related to COVID post-vaccination, in the Adriatic Ionian area (ADRION).
The content is very interesting. However, I would suggest some possible improvements left to the parties (authors and editor). These additions would be aimed at:
· Emphasize the importance of a collaborative project of these characteristics:
o Diverse nations in collaboration
o Diverse public administrations
o Different professional orientations: Neurologists, Administrators, Information experts, Technologists...
· I don't know where it fits to address these issues, but they should be specified somewhere. If not in this paper, then in some other future paper:
o Type of health systems (especially the structure of care services).
o Different socioeconomic situations
o Rates of Aging (specify data)
o Cultural aspects and current extent of the use of technologies
· Evaluation:
o What type of evaluation will be done?
o On what aspects?
o With what instruments?
In conclusion, the Brief Report is a very good start to the work of presenting the project and, in my opinion, it would be useful to have an introduction explaining the region, the importance of the collaboration, the reality of aging, the health system and the evaluation of the project that we propose to carry out. In my opinion it would improve with the incorporation of some of the suggestions I make to the authors.
Congrats again.
Author Response
To COVID
Editor in Chief
From Pietro Hiram Guzzi, on the behalf of all the authors.
Object: Manuscript updates for reviewer’s answer
Dear Editor,
First of all let us thank the anonymous reviewers for the observations on the manuscript. We went through the observations and we updated the manuscript as detailed below. We kindly ask you to consider the revised version and we hope that it may be considered for further revision. The proposed updates according to reviewer’s observations are highlighted in bold throughout the manuscript.
Moreover, we tried to answer to reviewers, proposing the following answers.
Looking forward to hearing from you,
best regards
Pietro Hiram Guzzi, on behalf of the authors.
Response to reviewers observations.
Reviewer 1
Reviewer Please check carefully the paper because there are a few typos and misspellings.
Answer: We checked the paper with the help of a native english speaker.
Reviewer: Please give some more details on the database's dimension and provide some more cybersecurity information.
Answer: We provided such information on the manuscript.
Reviewer: Please consider mentioning, even briefly, and referencing any recent bibliography item about topology-aware optimization strategies for minimizing virus spreading.
Answer: We thank you for this observation. We added these references.
Reviewer 2
The content is very interesting.
Answer: We thank the reviewer for the appreciation.
However, I would suggest some possible improvements left to the parties (authors and editor). These additions would be aimed at:
- Emphasize the importance of a collaborative project of these characteristics:
o Diverse nations in collaboration
o Diverse public administrations
o Different professional orientations: Neurologists, Administrators, Information experts, Technologists...
Answer: We added such information on the manuscript.
The transnational cooperation among diverse public administrations and different professional orientations is the key aspect of the SI4CARE project, since all the partners share the priority interest of the innovation of healthcare services for the elderly population through the application and combination of tools, procedures, actors and stakeholders. The rationale of the integration is that regional and local best practices in Social Innovation for healthcare service improvement do exist, but are often circumscribed to single cases, isolated and lack penetration into regional and national policies,. Consequently the need for an effort of cooperation and integration arises. Therefore the transnational and interdisciplinary approach is needed to share experiences, to scout for best practices and to effectively solution achieving real innovation and replicability. Finally, the personalized medicine approach is dependent from the availability of data at transnational level and standard for collecting them.
Reviewer I don't know where it fits to address these issues, but they should be specified somewhere. If not in this paper, then in some other future paper:
o Type of health systems (especially the structure of care services).
o Different socioeconomic situations
o Rates of Aging (specify data)
o Cultural aspects and current extent of the use of technologies
Answer: We thank the reviewer for the observation. All these data have been collected and reported in the Status Quo section of the project. We plan to discuss them in a review paper focused on the demographic and socio economic aspects.·
Evaluation:
o What type of evaluation will be done?
o On what aspects?
o With what instruments?
Answer: we plan to do a dual kind of evaluation. First a medical evaluation of the results in terms of the ability of the system to predict possible adverse events. We plan to learn a deep neural network based on a LSTM architecture that is able to predict adverse events, or simply events that should be reported, on the basis of the time series analysis. Furthermore, in relation with the aims of the project, we plan to demonstrate the effectiveness of the system in terms of well being of the patients and in the improvement of the healthcare system in term of the monitoring of patients.
Reviewer: In conclusion, the Brief Report is a very good start to the work of presenting the project and, in my opinion, it would be useful to have an introduction explaining the region, the importance of the collaboration, the reality of aging, the health system and the evaluation of the project that we propose to carry out. In my opinion it would improve with the incorporation of some of the suggestions I make to the authors.
We thank you for your attention, we added some of the suggestions in the paper.
Reviewer 3:
Reviewer:. As a general drawback, I could say that there is no reference to similar works that used wearables and deep learning methods (e.g. [1], [2]) in different health monitoring areas:
[1] Daskalos A-C, Theodoropoulos P, Spandonidis C, Vordos N. Wearable Device for Observation of Physical Activity with the Purpose of Patient Monitoring Due to COVID-19. Signals. 2022; 3(1):11-28.
[2] Viciano-Tudela, S., Sendra, S., Lloret, J., Tomas, J., & Belda-Ramirez, J. (2022). Development of a Low-Cost Pulse Oximeter for Taking Medical-Scientific Parameters to Monitor Remote Patients. Electronics, 11(19), 3061.
Answer: We apologize for missing such important information, we added these references.
Reviewer 2. More or less all fundamental theory details that are needed are discussed and a review of the problem under evaluation is sufficient. It would be beneficial to clarify the reasoning and the behind the selection of the methods.
Answer: We apologize for the lack of clarity, we added a discussion of the selection of the methods in the manuscript. We should note that the selection of the wearable devices, among the available ones, has been determined by the Calabria Region rules. The device we selected is currently the one certified by the Calabria region, so considering a possible future application in the real healthcare scenario we have to fulfill all the requirements of the Calabria Region,
Reviewer: 3. In addition, the authors could clarify the novelty and impact of their work. The work resembles an early-stage conference paper rather than a research article.
Answer: We added a section at the end of the introduction discussing novelty and impact of the work.
Reviewer: 4. In the same direction, authors should enhance the results section which is limited to a small paragraph.
Answer: we restructured the results section by adding more contents.
Reviewer 3 Report
The authors have made an overview of the topic and a concise reference to existing literature. They have indicated the main task of the paper. Some comments for improvement:
1. As a general drawback, I could say that there is no reference to similar works that used wearables and deep learning methods (e.g. [1], [2]) in different health monitoring areas:
[1] Daskalos A-C, Theodoropoulos P, Spandonidis C, Vordos N. Wearable Device for Observation of Physical Activity with the Purpose of Patient Monitoring Due to COVID-19. Signals. 2022; 3(1):11-28.
[2] Viciano-Tudela, S., Sendra, S., Lloret, J., Tomas, J., & Belda-Ramirez, J. (2022). Development of a Low-Cost Pulse Oximeter for Taking Medical-Scientific Parameters to Monitor Remote Patients. Electronics, 11(19), 3061.
2. More or less all fundamental theory details that are needed are discussed and a review of the problem under evaluation is sufficient. It would be beneficial to clarify the reasoning and the behind the selection of the methods.
3. In addition, the authors could clarify the novelty and impact of their work. The work resembles an early-stage conference paper rather that a research article.
4. In the same direction, authors should enhance the results section which is limited to a small paragraph.
Author Response
To COVID
Editor in Chief
From Pietro Hiram Guzzi, on the behalf of all the authors.
Object: Manuscript updates for reviewer’s answer
Dear Editor,
First of all let us thank the anonymous reviewers for the observations on the manuscript. We went through the observations and we updated the manuscript as detailed below. We kindly ask you to consider the revised version and we hope that it may be considered for further revision. The proposed updates according to reviewer’s observations are highlighted in bold throughout the manuscript.
Moreover, we tried to answer to reviewers, proposing the following answers.
Looking forward to hearing from you,
best regards
Pietro Hiram Guzzi, on behalf of the authors.
Response to reviewers observations.
Reviewer 1
Reviewer Please check carefully the paper because there are a few typos and misspellings.
Answer: We checked the paper with the help of a native english speaker.
Reviewer: Please give some more details on the database's dimension and provide some more cybersecurity information.
Answer: We provided such information on the manuscript.
Reviewer: Please consider mentioning, even briefly, and referencing any recent bibliography item about topology-aware optimization strategies for minimizing virus spreading.
Answer: We thank you for this observation. We added these references.
Reviewer 2
The content is very interesting.
Answer: We thank the reviewer for the appreciation.
However, I would suggest some possible improvements left to the parties (authors and editor). These additions would be aimed at:
- Emphasize the importance of a collaborative project of these characteristics:
o Diverse nations in collaboration
o Diverse public administrations
o Different professional orientations: Neurologists, Administrators, Information experts, Technologists...
Answer: We added such information on the manuscript.
The transnational cooperation among diverse public administrations and different professional orientations is the key aspect of the SI4CARE project, since all the partners share the priority interest of the innovation of healthcare services for the elderly population through the application and combination of tools, procedures, actors and stakeholders. The rationale of the integration is that regional and local best practices in Social Innovation for healthcare service improvement do exist, but are often circumscribed to single cases, isolated and lack penetration into regional and national policies,. Consequently the need for an effort of cooperation and integration arises. Therefore the transnational and interdisciplinary approach is needed to share experiences, to scout for best practices and to effectively solution achieving real innovation and replicability. Finally, the personalized medicine approach is dependent from the availability of data at transnational level and standard for collecting them.
Reviewer I don't know where it fits to address these issues, but they should be specified somewhere. If not in this paper, then in some other future paper:
o Type of health systems (especially the structure of care services).
o Different socioeconomic situations
o Rates of Aging (specify data)
o Cultural aspects and current extent of the use of technologies
Answer: We thank the reviewer for the observation. All these data have been collected and reported in the Status Quo section of the project. We plan to discuss them in a review paper focused on the demographic and socio economic aspects.·
Evaluation:
o What type of evaluation will be done?
o On what aspects?
o With what instruments?
Answer: we plan to do a dual kind of evaluation. First a medical evaluation of the results in terms of the ability of the system to predict possible adverse events. We plan to learn a deep neural network based on a LSTM architecture that is able to predict adverse events, or simply events that should be reported, on the basis of the time series analysis. Furthermore, in relation with the aims of the project, we plan to demonstrate the effectiveness of the system in terms of well being of the patients and in the improvement of the healthcare system in term of the monitoring of patients.
Reviewer: In conclusion, the Brief Report is a very good start to the work of presenting the project and, in my opinion, it would be useful to have an introduction explaining the region, the importance of the collaboration, the reality of aging, the health system and the evaluation of the project that we propose to carry out. In my opinion it would improve with the incorporation of some of the suggestions I make to the authors.
We thank you for your attention, we added some of the suggestions in the paper.
Reviewer 3:
Reviewer:. As a general drawback, I could say that there is no reference to similar works that used wearables and deep learning methods (e.g. [1], [2]) in different health monitoring areas:
[1] Daskalos A-C, Theodoropoulos P, Spandonidis C, Vordos N. Wearable Device for Observation of Physical Activity with the Purpose of Patient Monitoring Due to COVID-19. Signals. 2022; 3(1):11-28.
[2] Viciano-Tudela, S., Sendra, S., Lloret, J., Tomas, J., & Belda-Ramirez, J. (2022). Development of a Low-Cost Pulse Oximeter for Taking Medical-Scientific Parameters to Monitor Remote Patients. Electronics, 11(19), 3061.
Answer: We apologize for missing such important information, we added these references.
Reviewer 2. More or less all fundamental theory details that are needed are discussed and a review of the problem under evaluation is sufficient. It would be beneficial to clarify the reasoning and the behind the selection of the methods.
Answer: We apologize for the lack of clarity, we added a discussion of the selection of the methods in the manuscript. We should note that the selection of the wearable devices, among the available ones, has been determined by the Calabria Region rules. The device we selected is currently the one certified by the Calabria region, so considering a possible future application in the real healthcare scenario we have to fulfill all the requirements of the Calabria Region,
Reviewer: 3. In addition, the authors could clarify the novelty and impact of their work. The work resembles an early-stage conference paper rather than a research article.
Answer: We added a section at the end of the introduction discussing novelty and impact of the work.
Reviewer: 4. In the same direction, authors should enhance the results section which is limited to a small paragraph.
Answer: we restructured the results section by adding more contents.
