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Donisi V, De Lucia A, Pasini I, Gandolfi M, Schweiger V, Del Piccolo L, Perlini C. e-Health Interventions Targeting Pain-Related Psychological Variables in Fibromyalgia: A Systematic Review. Healthcare (Basel) 2023; 11:1845. [PMID: 37444679 DOI: 10.3390/healthcare11131845] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/05/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023] Open
Abstract
There is growing evidence to support the potential benefit of e-Health interventions targeting psychosocial outcomes and/or pain-related psychological variables for chronic pain conditions, including fibromyalgia syndrome (FMS). This systematic review aims at providing an in-depth description of the available e-Health psychological and/or multicomponent interventions for patients with FMS. Searches were made in PubMed, Cochrane, Web of Science, and PsycINFO up to 15 May 2023, finally including twenty-six articles. The quality of the included articles was medium-high (average quality assessment score of 77.1%). 50% of studies were randomized controlled trials (RCTs) (n = 13), and the majority of them focused exclusively on adult patients with FMS (n = 23) who were predominantly female. Four categories of e-Health modalities were identified: web-based (n = 19), mobile application (m-Health) (n = 3), virtual reality (VR) (n = 2), and video consulting (n = 2). Interventions were mainly based on the cognitive behavioral therapy (CBT) approach (n = 14) and mostly involved contact with a healthcare professional through different digital tools. Overall, a growing number of psychological and multicomponent interventions have been created and delivered using digital tools in the context of FMS, showing their potentiality for improving psychosocial outcomes and pain-related psychological variables. However, some digital tools resulted as underrepresented, and the literature on this topic appears highly heterogeneous precluding robust conclusions.
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Affiliation(s)
- Valeria Donisi
- Section of Clinical Psychology, Department of Neuroscience, Biomedicine and Movement Science, University of Verona, 37134 Verona, Italy
| | - Annalisa De Lucia
- Section of Clinical Psychology, Department of Neuroscience, Biomedicine and Movement Science, University of Verona, 37134 Verona, Italy
| | - Ilenia Pasini
- Section of Clinical Psychology, Department of Neuroscience, Biomedicine and Movement Science, University of Verona, 37134 Verona, Italy
| | - Marialuisa Gandolfi
- UOC Neurorehabilitation, Department of Neurosciences, Biomedicine and Movement Sciences, Neuromotor and Cognitive Rehabilitation Research Centre (CRRNC), University of Verona, Policlinico GB Rossi, 37134 Verona, Italy
| | - Vittorio Schweiger
- Pain Therapy Centre, Department of Surgery, Dentistry, Maternal and Infant Sciences, Verona University Hospital, Policlinico GB Rossi, 37134 Verona, Italy
| | - Lidia Del Piccolo
- Section of Clinical Psychology, Department of Neuroscience, Biomedicine and Movement Science, University of Verona, 37134 Verona, Italy
| | - Cinzia Perlini
- Section of Clinical Psychology, Department of Neuroscience, Biomedicine and Movement Science, University of Verona, 37134 Verona, Italy
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Balk EM, Danilack VA, Cao W, Bhuma MR, Adam GP, Konnyu KJ, Peahl AF. Televisits Compared With In-Person Visits for Routine Antenatal Care: A Systematic Review. Obstet Gynecol 2023; Publish Ahead of Print:00006250-990000000-00796. [PMID: 37290109 DOI: 10.1097/aog.0000000000005194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 02/23/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To compare benefits and harms of televisits and in-person visits in people receiving routine antenatal care. DATA SOURCES A search was conducted of PubMed, Cochrane databases, EMBASE, CINAHL, and ClinicalTrials.gov through February 12, 2022, for antenatal (prenatal) care, pregnancy, obstetrics, telemedicine, remote care, smartphones, telemonitoring, and related terms, as well as primary study designs. The search was restricted to high-income countries. METHODS OF STUDY SELECTION Double independent screening was done in Abstrackr for studies comparing televisits and in-person routine antenatal care visits for maternal, child, health care utilization, and harm outcomes. Data were extracted into SRDRplus with review by a second researcher. TABULATION, INTEGRATION, AND RESULTS Two randomized controlled trials, four nonrandomized comparative studies, and one survey compared visit types between 2004 and 2020, three of which were conducted during the coronavirus disease 2019 (COVID-19) pandemic. Number, timing, and mode of televisits and who provided care varied across studies. Low-strength evidence from studies comparing hybrid (televisits and in-person visits) and all in-person visits did not indicate differences in rates of neonatal intensive care unit admission of the newborn (summary odds ratio [OR] 1.02, 95% CI 0.82-1.28) or preterm births (summary OR 0.93, 95% CI 0.84-1.03). However, the studies with stronger, although still statistically nonsignificant, associations between use of hybrid visits and preterm birth compared the COVID-19 pandemic and prepandemic eras, confounding the association. There is low-strength evidence that satisfaction with overall antenatal care was greater in people who were pregnant and receiving hybrid visits. Other outcomes were sparsely reported. CONCLUSION People who are pregnant may prefer hybrid televisits and in-person visits. Although there is no evidence of differences in clinical outcomes between hybrid visits and in-person visits, the evidence is insufficient to evaluate most outcomes. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42021272287.
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Affiliation(s)
- Ethan M Balk
- Center for Evidence Synthesis in Health and the Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island; the Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; the Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China; and the Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor
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Albaghdadi AT, Al Daajani MM. Perceptions, Satisfaction, and Barriers to Telemedicine Use: A Community-Based Study From Jeddah, Saudi Arabia. Cureus 2023; 15:e40738. [PMID: 37485138 PMCID: PMC10361340 DOI: 10.7759/cureus.40738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2023] [Indexed: 07/25/2023] Open
Abstract
Background Telemedicine has expanded significantly, driven by technology and the necessity for accessible healthcare. However, users' knowledge, attitudes, and perceived barriers determine its application. This study aimed to assess these factors among patients in Jeddah, Saudi Arabia. Methodology We conducted a cross-sectional study on 403 participants from Ministry of Health centers in Jeddah from February to May 2023. A structured questionnaire was used for data collection, and subsequent analysis was performed using SPSS version 28.0 (IBM Corp., Armonk, NY, USA). Results Most participants (93.1%) agreed that telehealth services have improved healthcare accessibility and expressed willingness to participate in future telemedicine consultations. However, 73.7% felt potential embarrassment or discomfort due to camera and equipment presence. Remarkably, 76.2% of participants believed telemedicine suits all medical conditions, and 95% recommended its use. Barriers to telemedicine use were identified, including the need to travel to access healthcare services in the absence of telemedicine and the associated inconvenience and cost. The overall satisfaction score was 4.56 ± 0.78, with the highest satisfaction reported for the ability to talk freely over telemedicine (4.64 ± 0.76) and the ease of registration/scheduling (4.63 ± 0.82). Significant differences (p < 0.001) in satisfaction scores were found across various age groups, gender, nationality, employment status, and education level. Patients aged >55 years and those who used telemedicine services for the first time were associated with a significantly increased risk of poor satisfaction (odds ratio (OR) = 8.068, p = 0.011 and OR = 8.919, p = 0.005, respectively). Conclusions The findings suggest high satisfaction and positive attitudes toward telemedicine services in Jeddah, Saudi Arabia, despite identifiable barriers such as potential discomfort from camera presence. Patient age and familiarity with telemedicine services significantly influenced satisfaction levels, indicating areas that require attention for the successful implementation and expansion of telemedicine in Saudi Arabia.
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Affiliation(s)
- Abdullah T Albaghdadi
- Saudi Board of Preventive Medicine Program, Public Health Administration, Ministry of Health, Jeddah, SAU
| | - Manal M Al Daajani
- Saudi Board of Preventive Medicine Program, Public Health Administration, Ministry of Health, Jeddah, SAU
- Public Health Department, Jeddah Health Affairs, Jeddah, SAU
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Land MR, Patel PA, Bui T, Jiao C, Ali A, Ibnamasud S, Patel PN, Sheth V. Examining the Role of Telemedicine in Diabetic Retinopathy. J Clin Med 2023; 12:jcm12103537. [PMID: 37240642 DOI: 10.3390/jcm12103537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/21/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
With the increasing prevalence of diabetic retinopathy (DR), screening is of the utmost importance to prevent vision loss for patients and reduce financial costs for the healthcare system. Unfortunately, it appears that the capacity of optometrists and ophthalmologists to adequately perform in-person screenings of DR will be insufficient within the coming years. Telemedicine offers the opportunity to expand access to screening while reducing the economic and temporal burden associated with current in-person protocols. The present literature review summarizes the latest developments in telemedicine for DR screening, considerations for stakeholders, barriers to implementation, and future directions in this area. As the role of telemedicine in DR screening continues to expand, further work will be necessary to continually optimize practices and improve long-term patient outcomes.
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Affiliation(s)
- Matthew R Land
- Department of Ophthalmology, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Parth A Patel
- Department of Ophthalmology, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Tommy Bui
- Department of Ophthalmology, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Cheng Jiao
- Department of Ophthalmology, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Arsalan Ali
- Burnett School of Medicine, Texas Christian University, Fort Worth, TX 76129, USA
| | - Shadman Ibnamasud
- Department of Ophthalmology, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Prem N Patel
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Veeral Sheth
- Department of Ophthalmology, University Retina and Macula Associates, Oak Forest, IL 60452, USA
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Williams S, Ebrahimzadeh JE, Clay D, Constantino G, Heiman J, Wangensteen KJ, Valverde K, Mahmud N, Katona BW. Comparing telemedicine and in-person gastrointestinal cancer genetic appointment outcomes during the COVID-19 pandemic. Hered Cancer Clin Pract 2023; 21:6. [PMID: 37158974 PMCID: PMC10165576 DOI: 10.1186/s13053-023-00250-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 04/26/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND The study purpose is to compare outcomes associated with completion of genetic testing between telemedicine and in-person gastrointestinal cancer risk assessment appointments during the COVID-19 pandemic. METHODS Data was collected on patients with scheduled appointments between July 2020 and June 2021 in a gastrointestinal cancer risk evaluation program (GI-CREP) that utilized both telemedicine and in-person visits throughout the COVID-19 pandemic, and a survey was administered. RESULTS A total of 293 patients had a GI-CREP appointment scheduled and completion rates of in-person versus telemedicine appointments were similar. Individuals diagnosed with cancer and those with Medicaid insurance had lower rates of appointment completion. Although telehealth was the preferred visit modality, there were no differences in recommending genetic testing nor in the consent rate for genetic testing between in-person and telemedicine visits. However, of patients who consented for genetic testing, more than three times more patients seen via telemedicine did not complete genetic testing compared to those seen in-person (18.3% versus 5.2%, p = 0.008). Furthermore, telemedicine visits had a longer turnaround time for genetic test reporting (32 days versus 13 days, p < 0.001). CONCLUSIONS Compared to in-person GI-CREP appointments, telemedicine was associated with lower rates of genetic testing completion, and longer turnaround time for results.
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Affiliation(s)
- Samantha Williams
- Master of Science in Genetic Counseling Program, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Jessica E Ebrahimzadeh
- Division of Hematology/Oncology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Daniel Clay
- Division of Gastroenterology and Hepatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Gillian Constantino
- Division of Gastroenterology and Hepatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Jordan Heiman
- Division of Gastroenterology and Hepatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Kirk J Wangensteen
- Division of Gastroenterology and Hepatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Kathleen Valverde
- Master of Science in Genetic Counseling Program, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Nadim Mahmud
- Division of Gastroenterology and Hepatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Bryson W Katona
- Division of Gastroenterology and Hepatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
- Perelman Center for Advanced Medicine, University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Blvd 751 South Pavilion, Philadelphia, PA, 19104, USA.
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Cunha AS, Pedro AR, Cordeiro JV. Facilitators and barriers to access hospital medical specialty telemedicine consultations during the COVID-19 pandemic: Systematic Review. J Med Internet Res 2023. [PMID: 37262124 DOI: 10.2196/44188] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND COVID-19 pandemic accelerated the digital transition in healthcare, which required a rapid adaptation of stakeholders. Telemedicine has emerged as an ideal tool to ensure continuity of care by allowing remote access to specialized medical services. However, its rapid implementation has exacerbated disparities in healthcare access, especially for the most vulnerable populations. OBJECTIVE To characterize the determinants factors (facilitators and barriers) of access to hospital medical specialty telemedicine consultations during the COVID-19 pandemic; to identify the main opportunities and challenges (technological, ethical, legal and/or social) generated by the use of telemedicine in the context of the COVID-19 pandemic. METHODS A systematic review was conducted according to PRISMA guidelines. Four databases (Scopus, Web of Science, PubMed and Cochrane COVID-19 Study Register) were searched for empirical studies published between January 3rd, 2020, and December 31st, 2021, using established criteria. The protocol of this review was registered and published in PROSPERO (CRD42022302825). A methodological quality assessment was performed, and results were integrated into a thematic synthesis. The identification of main opportunities and challenges was done by interpreting and aggregating the thematic synthesis results. RESULTS Of the 106 studies identified, 9 met the inclusion criteria and the intended quality characteristics. All studies were originally from the United States of America (USA). The following facilitating factors of telemedicine use were identified: health insurance coverage; prevention of SARS-CoV-2 infection; access to Internet services; access to technological devices; better management of work-life balance; and savings in travel costs. We identified the following barriers to telemedicine use: lack of access to Internet services; lack of access to technological devices; racial and ethnic disparities; low digital literacy; low income; age; language barriers; health insurance coverage; concerns about data privacy and confidentiality; geographic disparities; and need for complementary diagnostic tests or for the delivery of test results. CONCLUSIONS The facilitating factors and barriers identified in this systematic review present different opportunities and challenges, including those of technological nature (access to technological devices and internet services, level of digital literacy), sociocultural and demographic nature (ethnic and racial disparities, geographical disparities, language barriers, age), socioeconomic nature (income level and health insurance coverage), and ethical and legal nature (data privacy and confidentiality). To expand telemedicine access to hospital-based specialty medical consultations and provide high-quality care to all, including the most vulnerable communities, the challenges identified must be thoroughly researched and addressed with informed and dedicated responses. CLINICALTRIAL
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Affiliation(s)
- Ana Soraia Cunha
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal, Avenida Padre Cruz, Lisbon, PT
| | - Ana Rita Pedro
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal, Lisbon, PT
| | - João Valente Cordeiro
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal, Lisbon, PT
- Interdisciplinary Centre of Social Sciences (CICS.NOVA), Universidade NOVA de Lisboa, Lisbon, Portugal, Lisbon, PT
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Bückmann A, Bernhardt F, Eveslage M, Storck M, Thölking G, Buss H, Domagk D, Juhra C, Lenz P. Telemedical Consultations in Palliative Care: Benefits through Knowledge Exchange and Intercollegiate Collaboration-Findings from the German oVID Project. Cancers (Basel) 2023; 15:cancers15092512. [PMID: 37173978 PMCID: PMC10177576 DOI: 10.3390/cancers15092512] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/19/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023] Open
Abstract
(1) Background: As the number of people receiving specialized palliative care (PC) continues to rise, there is a need to ensure the transfer of this expertise from university-based PC departments to primary care hospitals without such in-house access. The present study examines the potential of telemedicine to bridge these gaps. (2) Methods: This is a prospective multi-center feasibility trial. All physicians were appropriately pre-equipped and instructed to conduct telemedical consultations (TCs), which took place within fixed meetings or on-call appointments either related or unrelated to individual patients (allowing TCs also for educational and knowledge exchange purposes). (3) Results: An inquiry for participation was submitted to 11 hospitals, with 5 external hospitals actively cooperating. In the first study section, a total of 57 patient cases were included within 95 patient-related TCs during 80 meetings. Other university disciplines were involved in 21 meetings (26.2%). Therapy adjustments resulted following 25 of 71 affected TCs (35.2%). In 20 cases (21.1%), an on-site consultation at the university hospital was avoided, and in 12 cases (12.6%), a transfer was avoided. Overall, TCs were considered helpful in resolving issues for 97.9% of the cases (n = 93). Yet, technical problems arose in about one-third of all meetings for at least one physician (36.2%; n = 29). Besides, in the second study section, we also conducted 43 meetings between physicians for education and knowledge exchange only. (4) Conclusions: Telemedicine has the potential to transfer university expertise to external hospitals through simple means. It improves collaboration among physicians, may prevent unnecessary transfers or outpatient presentations, and is thus likely to lower costs.
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Affiliation(s)
- Andreas Bückmann
- Department of Palliative Care, University Hospital Muenster, 48149 Muenster, Germany
- West German Cancer Center Consortium (WTZ), Network Partner Muenster, University Hospital Muenster, 48149 Muenster, Germany
| | - Florian Bernhardt
- Department of Palliative Care, University Hospital Muenster, 48149 Muenster, Germany
- West German Cancer Center Consortium (WTZ), Network Partner Muenster, University Hospital Muenster, 48149 Muenster, Germany
| | - Maria Eveslage
- Institute of Biostatistics and Clinical Research, University of Muenster, 48149 Muenster, Germany
| | - Michael Storck
- Institute of Medical Informatics, University of Muenster, 48149 Muenster, Germany
| | - Gerold Thölking
- Department of Internal Medicine and Nephrology, University Hospital Muenster Marienhospital Steinfurt, 48565 Steinfurt, Germany
| | - Helga Buss
- Department of Geriatrics, EVK Muenster Alexianer Johannisstift GmbH, 48147 Muenster, Germany
| | - Dirk Domagk
- Department of Medicine I: Internal Medicine and Gastroenterology, Josephs-Hospital Warendorf, Academic Teaching Hospital of the University of Muenster, 48231 Warendorf, Germany
| | - Christian Juhra
- Office for eHealth, University Hospital Muenster, 48149 Muenster, Germany
| | - Philipp Lenz
- Department of Palliative Care, University Hospital Muenster, 48149 Muenster, Germany
- West German Cancer Center Consortium (WTZ), Network Partner Muenster, University Hospital Muenster, 48149 Muenster, Germany
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Best Practices for Providing Patient-Centered Tele-Palliative Care to Cancer Patients. Cancers (Basel) 2023; 15:cancers15061809. [PMID: 36980695 PMCID: PMC10046317 DOI: 10.3390/cancers15061809] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/10/2023] [Accepted: 03/15/2023] [Indexed: 03/19/2023] Open
Abstract
Cancer patients receiving palliative care may face significant challenges in attending outpatient appointments. Patients on controlled substances such as opioids require frequent visits and often rely on assistive devices and/or a caregiver to accompany them to these visits. In addition, pain, fatigue, and shortness of breath may magnify the challenges associated with in-person visits. The rapid adoption of telemedicine in response to the COVID-19 pandemic has proven to be highly beneficial for advanced cancer patients and caregivers. The hurried COVID-19-related implementation of telemedicine is now evolving into a permanent platform for providing palliative care. This review will focus on the best practices and recommendations to deliver high-quality, interdisciplinary tele-palliative care.
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Amendolara A, Noonan E. Telemedicine, Isolation, and Anxiety: The Impact of COVID-19 Lockdowns on an 87-Year-Old Woman. Cureus 2023; 15:e36195. [PMID: 37065320 PMCID: PMC10104680 DOI: 10.7759/cureus.36195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2023] [Indexed: 03/17/2023] Open
Abstract
This report describes an 87-year-old female who received cognitive behavioral therapy and medication for anxiety before, during, and after the coronavirus disease 2019 (COVID-19) lockdowns. Our objective is to highlight the impact of isolation, examine the use of telemedicine during the pandemic, and stress the importance of early implementation of this technology. To this end, a chart review of psychotherapy and psychiatry progress notes from 2019 to 2022 and a patient interview were utilized to assess the impact of COVID-19 and telemedicine on the patient's anxiety symptoms, feelings of isolation, and treatment plan. Feelings of isolation, especially, were exacerbated. Prior to the pandemic, the patient was extremely physically and socially active. The reduced ability to interact with others and maintain her independence was detrimental. As a result, COVID-19 impacted the patient's progress significantly and caused regression of symptoms. However, telemedicine allowed for the continuation of therapy and follow-up to the present time. Though telemedicine allowed the patient to receive regular care for the duration of the lockdown and to regain control of anxiety symptoms, she only recently became comfortable with the technology. Now, the patient prefers the convenience and ease of telemedicine, continues to receive care through this modality, and feels that her current care is equivalent to in-person therapy. This case report should serve as a reminder of the effect that isolation can have on older adults with pre-existing anxiety. Notably, isolation may be related to the recent COVID-19 pandemic or other factors, such as reduced mobility or limited access to social services. In any case, isolation has a substantial impact on older patients' mental health. And, despite the availability of telemedicine, clinicians should be aware of the technical challenges surrounding emergency implementation. We suggest early exposure to telemedicine for patients, as well as staff training focused on the potential technical limitations of those patients. We also suggest an assessment of technical literacy, conducted early on as part of a patient's initial intake. The main limitation of this report, and the conclusions drawn herein, is the lack of quantitative measures available. Thus, assessment of the patient's condition and symptoms was restricted to clinician assessment and self-reported measures. We feel though that this remains a useful example of the long-term benefit of telemedicine for older individuals.
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Cheikh Youssef S, Haram K, Noël J, Patel V, Porter J, Dasgupta P, Hachach-Haram N. Evolution of the digital operating room: the place of video technology in surgery. Langenbecks Arch Surg 2023; 408:95. [PMID: 36807211 PMCID: PMC9939374 DOI: 10.1007/s00423-023-02830-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 02/06/2023] [Indexed: 02/23/2023]
Abstract
PURPOSE The aim of this review was to collate current evidence wherein digitalisation, through the incorporation of video technology and artificial intelligence (AI), is being applied to the practice of surgery. Applications are vast, and the literature investigating the utility of surgical video and its synergy with AI has steadily increased over the last 2 decades. This type of technology is widespread in other industries, such as autonomy in transportation and manufacturing. METHODS Articles were identified primarily using the PubMed and MEDLINE databases. The MeSH terms used were "surgical education", "surgical video", "video labelling", "surgery", "surgical workflow", "telementoring", "telemedicine", "machine learning", "deep learning" and "operating room". Given the breadth of the subject and the scarcity of high-level data in certain areas, a narrative synthesis was selected over a meta-analysis or systematic review to allow for a focussed discussion of the topic. RESULTS Three main themes were identified and analysed throughout this review, (1) the multifaceted utility of surgical video recording, (2) teleconferencing/telemedicine and (3) artificial intelligence in the operating room. CONCLUSIONS Evidence suggests the routine collection of intraoperative data will be beneficial in the advancement of surgery, by driving standardised, evidence-based surgical care and personalised training of future surgeons. However, many barriers stand in the way of widespread implementation, necessitating close collaboration between surgeons, data scientists, medicolegal personnel and hospital policy makers.
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Affiliation(s)
| | | | - Jonathan Noël
- Guy's and St. Thomas' NHS Foundation Trust, Urology Centre, King's Health Partners, London, UK
| | - Vipul Patel
- Adventhealth Global Robotics Institute, 400 Celebration Place, Celebration, FL, USA
| | - James Porter
- Department of Urology, Swedish Urology Group, Seattle, WA, USA
| | - Prokar Dasgupta
- Guy's and St. Thomas' NHS Foundation Trust, Urology Centre, King's Health Partners, London, UK
| | - Nadine Hachach-Haram
- Department of Plastic Surgery, Guy's and St. Thomas' NHS Foundation Trust, King's Health Partners, London, UK
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How COVID-19 Broke the Barriers Related to the Implementation of Telecare-Patients' Experiences with a New form of Providing Health Services in Primary Health Care. Healthcare (Basel) 2023; 11:healthcare11040497. [PMID: 36833033 PMCID: PMC9956090 DOI: 10.3390/healthcare11040497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 01/30/2023] [Accepted: 02/07/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has significantly contributed to accelerating the development of telemedicine and eHealth. The main aim of this study was to assess the attitudes of patients towards remote care implemented in general practice (GP) during the pandemic. METHODS The study was a pilot study conducted in March-April 2021, considering technical aspects of using teleconsultations, and evaluating the difficulties, advantages and disadvantages for patients. When assessing opinions, a simple Likert scale was used, where a value of 1 meant the worst possible assessment or strong disagreement and the upper value the best or full agreement of the respondent. RESULTS The study covered 408 respondents. Their biggest organizational challenge reaching GPs by telephone, regardless of the patients' home location (p = 0.23698). Obtaining e-documents was not problematic but was rated as worse by men (p = 0.048295). Respondents rated the overall effectiveness of teleconsultations more highly if they could speak directly with a doctor (p = 0.0005). There were no differences in willingness to recommend teleconsultations based on gender (p = 0.2432), place of residence (p = 0.7878), age (p = 0.290355) or education (p = 0.9109), but people assessing the overall effectiveness of telemedicine more highly were more willing to recommend it (p = 0.000). CONCLUSIONS Respondents assess teleconsultations in a differentiated way, noticing both positive and negative features of the remote form of providing health services.
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Holt JM, Cusatis R, Mortensen N, Wolfrath N, Hyun N, Winn AN, Brown SA, Somai MM, Crotty BH. Twenty-first century house calls: a survey of ambulatory care providers to inform organisational telehealth strategy. BMJ Health Care Inform 2022; 29:bmjhci-2022-100626. [PMID: 36564094 PMCID: PMC9791455 DOI: 10.1136/bmjhci-2022-100626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 11/13/2022] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES While patient interest in telehealth increases, clinicians' perspectives may influence longer-term adoption. We sought to identify facilitators and barriers to continued clinician incorporation of telehealth into practice. METHODS A cross-sectional 24-item web-based survey was emailed to 491 providers with ≥50 video visits (VVs) within an academic health system between 1 March 2020 and 31 December 2020. We quantitatively summarised the characteristics and perceptions of respondents by using descriptive and test statistics. We used systematic content analysis to qualitatively code open-ended responses, double coding at least 25%. RESULTS 247 providers (50.3%) responded to the survey. Seventy-nine per cent were confident in their ability to deliver excellent clinical care through VV. In comparison, 48% were confident in their ability to troubleshoot technical issues. Most clinicians (87%) expressed various concerns about VV. Providers across specialties generally agreed that VV reduced infection risk (71%) and transportation barriers (71%). Three overarching themes in the qualitative data included infrastructure and training, usefulness and expectation setting for patients and providers. DISCUSSION As healthcare systems plan for future delivery directions, they must address the tension between patients' and providers' expectations of care within the digital space. Telehealth creates new friction, one where the healthcare system must fit into the patient's life rather than the usual dynamic of the patient fitting into the healthcare system. CONCLUSION Telehealth infrastructure and patient and clinician technological acumen continue to evolve. Clinicians in this survey offered valuable insights into the directions healthcare organisations can take to right-size this healthcare delivery modality.
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Affiliation(s)
- Jeana M Holt
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA,Family and Community Medicine, Medical College of Wisconsin Department of Family and Community Medicine, Milwaukee, Wisconsin, USA
| | - Rachel Cusatis
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Natalie Mortensen
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Nathan Wolfrath
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Noorie Hyun
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente, Seattle, Washington, USA
| | - Aaron N Winn
- School of Pharmacy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Sherry-Ann Brown
- Cardio-Oncology, Medical College of Wisconsin Cardiovascular Center, Milwaukee, Wisconsin, USA
| | - Melek M Somai
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Bradley H Crotty
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Greenhalgh T, Shaw SE, Alvarez Nishio A, Byng R, Clarke A, Dakin F, Faulkner S, Hemmings N, Husain L, Kalin A, Ladds E, Moore L, Rosen R, Rybczynska-Bunt S, Wherton J, Wieringa S. Remote care in UK general practice: baseline data on 11 case studies. NIHR OPEN RESEARCH 2022; 2:47. [PMID: 36814638 PMCID: PMC7614213 DOI: 10.3310/nihropenres.13290.2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/22/2022] [Indexed: 12/03/2022]
Abstract
Background Accessing and receiving care remotely (by telephone, video or online) became the default option during the coronavirus disease 2019 (COVID-19) pandemic, but in-person care has unique benefits in some circumstances. We are studying UK general practices as they try to balance remote and in-person care, with recurrent waves of COVID-19 and various post-pandemic backlogs. Methods Mixed-methods (mostly qualitative) case study across 11 general practices. Researchers-in-residence have built relationships with practices and become familiar with their contexts and activities; they are following their progress for two years via staff and patient interviews, documents and ethnography, and supporting improvement efforts through co-design. In this paper, we report baseline data. Results Reflecting our maximum-variety sampling strategy, the 11 practices vary in size, setting, ethos, staffing, population demographics and digital maturity, but share common contextual features-notably system-level stressors such as high workload and staff shortages, and UK's technical and regulatory infrastructure. We have identified both commonalities and differences between practices in terms of how they: 1] manage the 'digital front door' (access and triage) and balance demand and capacity; 2] strive for high standards of quality and safety; 3] ensure digital inclusion and mitigate wider inequalities; 4] support and train their staff (clinical and non-clinical), students and trainees; 5] select, install, pilot and use technologies and the digital infrastructure which support them; and 6] involve patients in their improvement efforts. Conclusions General practices' responses to pandemic-induced disruptive innovation appear unique and situated. We anticipate that by focusing on depth and detail, this longitudinal study will throw light on why a solution that works well in one practice does not work at all in another. As the study unfolds, we will explore how practices achieve timely diagnosis of urgent or serious illness and manage continuity of care, long-term conditions and complex needs.
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Affiliation(s)
- Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OXFORDSHIRE, OX2 6GG, UK
| | - Sara E. Shaw
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OXFORDSHIRE, OX2 6GG, UK
| | | | | | - Aileen Clarke
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OXFORDSHIRE, OX2 6GG, UK
| | - Francesca Dakin
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OXFORDSHIRE, OX2 6GG, UK
| | - Stuart Faulkner
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OXFORDSHIRE, OX2 6GG, UK
| | | | - Laiba Husain
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OXFORDSHIRE, OX2 6GG, UK
| | - Asli Kalin
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OXFORDSHIRE, OX2 6GG, UK
| | - Emma Ladds
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OXFORDSHIRE, OX2 6GG, UK
| | - Lucy Moore
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OXFORDSHIRE, OX2 6GG, UK
| | | | | | - Joseph Wherton
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OXFORDSHIRE, OX2 6GG, UK
| | - Sietse Wieringa
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OXFORDSHIRE, OX2 6GG, UK
- Centre for Sustainable Health Education, University of Oslo, Oslo, NO-0316, Norway
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Greenhalgh T, Shaw SE, Alvarez Nishio A, Byng R, Clarke A, Dakin F, Faulkner S, Hemmings N, Husain L, Kalin A, Ladds E, Moore L, Rosen R, Rybczynska-Bunt S, Wherton J, Wieringa S. Remote care in UK general practice: baseline data on 11 case studies. NIHR OPEN RESEARCH 2022; 2:47. [PMID: 36814638 PMCID: PMC7614213 DOI: 10.3310/nihropenres.13290.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/22/2022] [Indexed: 10/27/2023]
Abstract
BACKGROUND Accessing and receiving care remotely (by telephone, video or online) became the default option during the coronavirus disease 2019 (COVID-19) pandemic, but in-person care has unique benefits in some circumstances. We are studying UK general practices as they try to balance remote and in-person care, with recurrent waves of COVID-19 and various post-pandemic backlogs. METHODS Mixed-methods (mostly qualitative) case study across 11 general practices. Researchers-in-residence have built relationships with practices and become familiar with their contexts and activities; they are following their progress for two years via staff and patient interviews, documents and ethnography, and supporting improvement efforts through co-design. In this paper, we report baseline data. RESULTS Reflecting our maximum-variety sampling strategy, the 11 practices vary in size, setting, ethos, staffing, population demographics and digital maturity, but share common contextual features-notably system-level stressors such as high workload and staff shortages, and UK's technical and regulatory infrastructure. We have identified both commonalities and differences between practices in terms of how they: 1] manage the 'digital front door' (access and triage) and balance demand and capacity; 2] strive for high standards of quality and safety; 3] ensure digital inclusion and mitigate wider inequalities; 4] support and train their staff (clinical and non-clinical), students and trainees; 5] select, install, pilot and use technologies and the digital infrastructure which support them; and 6] involve patients in their improvement efforts. CONCLUSIONS General practices' responses to pandemic-induced disruptive innovation appear unique and situated. We anticipate that by focusing on depth and detail, this longitudinal study will throw light on why a solution that works well in one practice does not work at all in another. As the study unfolds, we will explore how practices achieve timely diagnosis of urgent or serious illness and manage continuity of care, long-term conditions and complex needs.
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Affiliation(s)
- Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OXFORDSHIRE, OX2 6GG, UK
| | - Sara E. Shaw
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OXFORDSHIRE, OX2 6GG, UK
| | | | | | - Aileen Clarke
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OXFORDSHIRE, OX2 6GG, UK
| | - Francesca Dakin
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OXFORDSHIRE, OX2 6GG, UK
| | - Stuart Faulkner
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OXFORDSHIRE, OX2 6GG, UK
| | | | - Laiba Husain
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OXFORDSHIRE, OX2 6GG, UK
| | - Asli Kalin
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OXFORDSHIRE, OX2 6GG, UK
| | - Emma Ladds
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OXFORDSHIRE, OX2 6GG, UK
| | - Lucy Moore
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OXFORDSHIRE, OX2 6GG, UK
| | | | | | - Joseph Wherton
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OXFORDSHIRE, OX2 6GG, UK
| | - Sietse Wieringa
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OXFORDSHIRE, OX2 6GG, UK
- Centre for Sustainable Health Education, University of Oslo, Oslo, NO-0316, Norway
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How Telemedicine Can Improve the Quality of Care for Patients with Alzheimer's Disease and Related Dementias? A Narrative Review. Medicina (B Aires) 2022; 58:medicina58121705. [PMID: 36556907 PMCID: PMC9783876 DOI: 10.3390/medicina58121705] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/13/2022] [Accepted: 11/20/2022] [Indexed: 11/24/2022] Open
Abstract
Background and Objectives: Dementia affects more than 55 million patients worldwide, with a significant societal, economic, and psychological impact. However, many patients with Alzheimer's disease (AD) and other related dementias have limited access to effective and individualized treatment. Care provision for dementia is often unequal, fragmented, and inefficient. The COVID-19 pandemic accelerated telemedicine use, which holds promising potential for addressing this important gap. In this narrative review, we aim to analyze and discuss how telemedicine can improve the quality of healthcare for AD and related dementias in a structured manner, based on the seven dimensions of healthcare quality defined by the World Health Organization (WHO), 2018: effectiveness, safety, people-centeredness, timeliness, equitability, integrated care, and efficiency. Materials and Methods: MEDLINE and Scopus databases were searched for peer-reviewed articles investigating the role of telemedicine in the quality of care for patients with dementia. A narrative synthesis was based on the seven WHO dimensions. Results: Most studies indicate that telemedicine is a valuable tool for AD and related dementias: it can improve effectiveness (better access to specialized care, accurate diagnosis, evidence-based treatment, avoidance of preventable hospitalizations), timeliness (reduction of waiting times and unnecessary transportation), patient-centeredness (personalized care for needs and values), safety (appropriate treatment, reduction of infection risk),integrated care (interdisciplinary approach through several dementia-related services), efficiency (mainly cost-effectiveness) and equitability (overcoming geographical barriers, cultural diversities). However, digital illiteracy, legal and organizational issues, as well as limited awareness, are significant potential barriers. Conclusions: Telemedicine may significantly improve all aspects of the quality of care for patients with dementia. However, future longitudinal studies with control groups including participants of a wide educational level spectrum will aid in our deeper understanding of the real impact of telemedicine in quality care for this population.
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Radix AE, Bond K, Carneiro PB, Restar A. Transgender Individuals and Digital Health. Curr HIV/AIDS Rep 2022; 19:592-599. [PMID: 36136217 PMCID: PMC9493149 DOI: 10.1007/s11904-022-00629-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE OF REVIEW The goal of this review is to assess the use of digital technologies to promote the health and well-being of transgender and gender diverse (TGD) people. RECENT FINDINGS TGD individuals experience numerous health disparities, including low uptake of HIV prevention strategies, such as pre-exposure prophylaxis, increased HIV incidence, and suboptimal HIV-related outcomes. These health disparities are the result of widespread intersectional stigma on the basis of gender identity, gender expression, socioeconomic class, race, and ethnicity, which negatively impact access to general medical and transgender-specific health care. TGD individuals often delay or avoid essential medical services due to fear of discrimination. Clinicians frequently lack training, competence, and skills in transgender medicine, further exacerbating the health disparities faced by TGD people. Digital technologies have been used to improve research and clinical care for TGD populations through various modalities; telemedicine, telehealth and mHealth. Digital health technologies, including HIT-enabled clinical decision support, telehealth, telemedicine, and mHealth, offer innovative ways to improve health care access, improve quality of care, and reduce health disparities for TGD populations, including and beyond HIV outcomes, through enhanced care delivery, clinician education, and enhancing social support networks.
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Affiliation(s)
- Asa E. Radix
- Department of Medicine, Callen-Lorde Community Health Center, New York, NY USA ,NYU Grossman School of Medicine, New York, NY USA
| | - Keosha Bond
- Community Health & Social Medicine, CUNY School of Medicine, New York, NY USA
| | - Pedro B. Carneiro
- Department of Community Health and Social Sciences, City University of New York, New York, NY USA
| | - Arjee Restar
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA USA
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