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Shah SR, Munhall CC, Nguyen SA, O'Rourke AK, Miccichi K, Meyer TA. Diagnostic accuracy and management concordance of otorhinolaryngological diseases through telehealth or remote visits: A systematic review & meta-analysis. J Telemed Telecare 2024; 30:1386-1397. [PMID: 36916306 DOI: 10.1177/1357633x231156207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
INTRODUCTION COVID-19 has led to delays in providing healthcare in both emergency and non-emergency settings, especially in surgical subspecialties which rely heavily on referrals and in-person visits. Without an established telehealth infrastructure, many otorhinolaryngological departments experienced decreases in consultations. Telemedicine has attempted to bridge the gap between pre- and post-pandemic periods by creating a safe avenue of communication between otorhinolaryngologists and patients. This review hopes to address the accuracy of telemedicine in patient diagnosis and management. METHODS Searches were conducted since study conception until June 30, 2022, on multiple databases including PubMed, SCOPUS, and CINAHL for this systematic review and meta-analysis. Diagnostic accuracy, management accuracy, kappa, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were meta-analyzed by comparing virtual visits to in-person visits (gold standard). RESULTS Nineteen studies were included in this review. A total of 1518 patients were included across all studies. When comparing virtual visits against in-person visits, accurate diagnosis was made in 86.2% [82.1,89.9, I2 = 73.5%, P < 0.0001] of patients and management accuracy was 91.5% [86.1,95.7, I2 = 81.8%, P < 0.0001] when treating patients. Kappa value determining interrater reliability was 0.8 [0.7,0.9, I2 = 81.8%, P < 0.0001]. CONCLUSION Our data suggest that diagnostic and management concordance is above 80% when comparing diagnosis and management strategies in patients who underwent both telehealth and in-person visits with an otorhinolaryngologist. In uncomplicated patients, telehealth might be a reliable source for diagnosis and management however, in-person consultation is likely still required for pathologies in which physical exam, imaging or procedural elements represent a vital component of the work-up.
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Affiliation(s)
- Sunny R Shah
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Christopher C Munhall
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Shaun A Nguyen
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Ashli K O'Rourke
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Kate Miccichi
- Department of IT Telemedicine, McLeod Health, Florence, SC, USA
| | - Ted A Meyer
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
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Bradley M, Shields C, Sabourn R, Whittle E, Boyd R, Bruce IA, Nichani J. Paediatric percutaneous bone anchored hearing aid implant failures: Comparing the experience of a tertiary centre with a systematic review of the literature and meta-analysis. Cochlear Implants Int 2024:1-13. [PMID: 38591756 DOI: 10.1080/14670100.2024.2332036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
BACKGROUND Despite the proven audiological benefits of Percutaneous Bone Anchored Hearing Aids (BAHAs) in paediatric patients with conductive or mixed hearing loss, their adoption has been limited due to concerns over implant failure and associated complications. This paper conducts a systematic review and meta-analysis to assess the prevalence of implant failure in paediatric populations, combined with a case series from our tertiary referral centre. METHODS A comprehensive literature search identified 562 articles, from which 34 were included in the review, covering 1599 implants in 1285 patients. Our retrospective case series included consecutive patients from our tertiary referral centre who underwent percutaneous BAHA implantation from 2003-2019. RESULTS Meta-analysis revealed an overall implant failure rate of 11%, predominantly attributed to traumatic extrusion. Our retrospective case series comprised 104 implantations in 76 patients, with a 4.8% failure rate. DISCUSSION Factors contributing to the lower-than-expected failure rates in the case series likely included consistent use of 4 mm fixtures from a single manufacturer and older age at implantation. The study underscores the need for standardised reporting formats in bone conduction implants research, given the systematic review's limitations in study design heterogeneity, especially with the expected rise in the adoption of novel active devices.
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Affiliation(s)
- Matthew Bradley
- Department of Paediatric Otolaryngology, Royal Manchester Children's Hospital, Manchester, UK
| | - Callum Shields
- Department of Paediatric Otolaryngology, Royal Manchester Children's Hospital, Manchester, UK
- Department of Health Sciences, University of Manchester, Manchester, UK
| | - Robert Sabourn
- Department of Health Sciences, University of Manchester, Manchester, UK
| | | | - Rachel Boyd
- Audiology, Royal Manchester Children's Hospital, Manchester, UK
| | - Iain Alexander Bruce
- Department of Paediatric Otolaryngology, Royal Manchester Children's Hospital, Manchester, UK
- Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Jaya Nichani
- Department of Paediatric Otolaryngology, Royal Manchester Children's Hospital, Manchester, UK
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Levy L, Villavisanis DF, Sarosi AJ, Taub PJ. Pediatric Plastic Surgery in the COVID-19 Era. Ann Plast Surg 2024; 92:335-339. [PMID: 38394272 DOI: 10.1097/sap.0000000000003810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
ABSTRACT The COVID-19 pandemic has forced the healthcare system to adopt novel strategies to treat patients. Pediatric plastic surgeons are uniquely exposed to high rates of infections during examinations and surgeries via aerosol-generating procedures, in part because of the predilection of viral particles for the nasal cavities and pharynx. Telemedicine has emerged as a useful virtual medium for encouraging prolonged patient follow-up while maintaining physical distance. It has proven beneficial in mitigating infection risks while decreasing the financial burden on patients, their families, and healthcare teams. New trends driven by the pandemic added multiple elements to the patient-physician relationship and have left a lasting impact on the field of pediatric plastic surgery in clinical guidelines, surgical care, and patient outcomes. Lessons learned help inform pediatric plastic surgeons on how to reduce future viral infection risk and lead a more appropriately efficient surgical team depending on early triage.
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Affiliation(s)
- Lior Levy
- From the Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
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4
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Lorenz FJ, Heikel T, Tucker J, Lin A, Gniady JP, Goldenberg D. Telemedicine in Otolaryngology in the Context of the End of the COVID-19 Public Health Emergency. Otolaryngol Head Neck Surg 2024; 170:624-626. [PMID: 37787032 DOI: 10.1002/ohn.550] [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: 06/19/2023] [Revised: 08/25/2023] [Accepted: 09/07/2023] [Indexed: 10/04/2023]
Abstract
At the onset of the COVID-19 pandemic, the US Department of Health and Human Services implemented a range of flexibilities to expedite the adoption of telehealth. As our specialty moved past the height of the pandemic and the use of telehealth transitioned from a necessity to a convenience, numerous health care providers (physicians, advanced practice providers, speech-language pathologists, and audiologists) recognized its benefits and continued to offer these services. In May 2023, the current administration terminated the COVID-19 public health emergency declaration, with some telehealth guidelines in effect until December 31, 2023, and others extended through December 31, 2024. Amidst the changing telehealth landscape, the objective of this commentary is to explain policy implications on Otolaryngology-Head and Neck Surgery and provide insight into how to best implement telehealth under these new guidelines.
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Affiliation(s)
- F Jeffrey Lorenz
- Department of Otolaryngology-Head and Neck Surgery, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Tiffany Heikel
- Department of Otolaryngology-Head and Neck Surgery, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Jacqueline Tucker
- College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Andrea Lin
- College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - John P Gniady
- Department of Otolaryngology-Head and Neck Surgery, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA
| | - David Goldenberg
- Department of Otolaryngology-Head and Neck Surgery, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA
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5
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Sousa LRD, Fraga GA, Costa ISPD, Almeida ACFD, Sassi TSDS, Lourençone LFM. Diagnostic accuracy of the video otoscope in tympanic membrane perforation. Braz J Otorhinolaryngol 2024; 90:101336. [PMID: 37839169 PMCID: PMC10582057 DOI: 10.1016/j.bjorl.2023.101336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/03/2023] [Accepted: 09/22/2023] [Indexed: 10/17/2023] Open
Abstract
OBJECTIVE The video otoscope has already proven to be useful for the diagnosis of several pathologies, so the objective of this study was to evaluate the diagnostic accuracy of the video otoscope in cases of tympanic membrane perforation. METHODS This is a diagnostic accuracy study performed at the hearing health division of a tertiary-level referral hospital. Patients older than 8 years of age who had any symptom that could be related to perforation (otalgia, otorrhea, tinnitus, and/or hypoacusis) were invited to participate in the study. Participants were evaluated by three different diagnostic methods (otomicroscope, conventional otoscope, and video otoscope) performed by three different evaluators in a blind fashion. The microscope was considered the reference standard. RESULTS 176 patients were evaluated, totaling 352 tympanic membranes. Twenty-seven tympanic membrane perforations were diagnosed by the microscope, a prevalence of 7.7%. The video otoscope showed a sensitivity of 85.2% (95% CI 81.5%‒88.9%), specificity of 98.1% (95% CI 96.7%‒99.5%) and accuracy of 97.1% (95% CI 95.4 %-98.8 %). The conventional otoscope showed a sensitivity of 96.3% (95% CI 94.3-98.3), specificity of 98.8% (95% CI 97.7-99.9) and accuracy of 98.6% (95% CI 97.4-99.8). The Kappa value between the microscope and the video otoscope was 0.8 and between the microscope and the conventional otoscope was 0.9. Regarding the participants' perception, 53.4% (p< 0.001) considered the video otoscope as the best method for understanding the tympanic membrane condition presented by them. CONCLUSIONS The video otoscope showed relevant sensitivity and specificity for clinical practice in the diagnosis of tympanic membrane perforation. Moreover, this is an equipment that can facilitate the patient's understanding of the otologic pathology presented by him/her. In this regard, this method may be important for better patient compliance, requiring further studies to evaluate this hypothesis. LEVEL OF EVIDENCE Is this diagnostic or monitoring test accurate? (Diagnosis)-Level 2 (Individual cross-sectional studies with consistently applied reference standard and blinding).
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Affiliation(s)
| | - Guilherme Adam Fraga
- Universidade de São Paulo, Hospital de Reabilitação de Anomalias Craniofaciais, Bauru, SP, Brazil
| | | | | | | | - Luiz Fernando Manzoni Lourençone
- Universidade de São Paulo, Faculdade de Odontologia de Bauru, Curso Médico, Bauru, SP, Brazil; Universidade de São Paulo, Hospital de Reabilitação de Anomalias Craniofaciais, Bauru, SP, Brazil.
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Miller LE, Xu L, Lorch AC, Armstrong GW, Agarwala AV, Naunheim MR. Patient and Visit Characteristics Associated With Otolaryngology Telemedicine Care. Ann Otol Rhinol Laryngol 2023; 132:1682-1685. [PMID: 37329265 DOI: 10.1177/00034894231180009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
BACKGROUND Clinicians are increasingly adopting telemedicine in an effort to expand patient access and efficiently deliver care. The degree of health disparities among patients receiving otolaryngologic telemedical care is unclear. AIMS We performed a retrospective cross-sectional study to explore disparities in telemedicine delivery. METHODS We evaluated otolaryngology clinical visits from January 2019 to November 2022. We obtained patient demographics and visit characteristics (e.g., subspecialty, telemedicine vs in-person). Our primary outcome was demographic characteristics of otolaryngology patients who received telemedicine vs in-person care during the study timeframe. RESULTS A total of 231,384 otolaryngology clinical visits were reviewed, of which 26,895 (11.6%) were telemedicine visits. Rhinology (36.5%) and facial plastics (28.4%) subspecialties performed the most telemedicine visits. On multivariate analysis, individuals who identified as Asian, non-English speaking, and with Medicare insurance were statistically significantly less likely to use telemedicine than in-person services. CONCLUSION Our findings suggest that expanding telemedicine care may not improve access for all populations, and socioeconomic factors are important considerations to ensure patients are receiving equally accessible care. Futures studies are warranted to understand how these disparities may impact health outcomes and patient satisfaction with care.
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Affiliation(s)
- Lauren E Miller
- Massachusetts Eye & Ear Infirmary, Boston, MA, USA
- Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
| | - Lucy Xu
- Massachusetts Eye & Ear Infirmary, Boston, MA, USA
- Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
| | - Alice C Lorch
- Massachusetts Eye & Ear Infirmary, Boston, MA, USA
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Grayson W Armstrong
- Massachusetts Eye & Ear Infirmary, Boston, MA, USA
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Aalok V Agarwala
- Massachusetts Eye & Ear Infirmary, Boston, MA, USA
- Department of Anesthesiology, Harvard Medical School, Boston, MA, USA
| | - Matthew R Naunheim
- Massachusetts Eye & Ear Infirmary, Boston, MA, USA
- Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
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Arrighi-Allisan AE, Wong A, Gidumal S, Shah J, Filip P, Omorogbe A, Rosenberg J, Govindaraj S, Iloreta AM. Otolaryngology Patient Satisfaction with In-Office Appointments and Virtual Visits Due to COVID-19. Ann Otol Rhinol Laryngol 2023; 132:1168-1176. [PMID: 36433692 PMCID: PMC9705504 DOI: 10.1177/00034894221137273] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
BACKGROUND The COVID-19 pandemic forced otolaryngologists to seek new methods of providing patient care in a remote setting. The effect of this paradigm shift on patient satisfaction, however, remains unelucidated. This study compares patient satisfaction with telehealth visits during the COVID-19 pandemic to that with in-office visits during the same period in 2019. METHODS Press Ganey survey responses of patients seen by otolaryngologists within a large, academic, multicenter hospital system were gathered. Responses were included in analyses if they corresponded with a visit that occurred either in clinic March to December 2019 or via telehealth March to December 2020. Chi-Square Test of Independence and Fisher's Exact Test were employed to detect differences between years. Binary logistic regressions were performed to detect the factors most predictive of positive telehealth experiences. RESULTS Patient overall satisfaction with in-office and telehealth visits did not differ significantly (76.4% in 2019 vs 78.0% in 2020 rated visit overall as "very good," P = .09). Patients seen by a Head and Neck (odds ratio 4.13, 95% confidence interval 1.52-11.26, P = .005), Laryngology (OR 5.96, 95% CI 1.51-23.50, P = .01), or Rhinology (OR 4.02, 95% CI 1.55-10.43, P = .004) provider were significantly more likely to report a positive telehealth experience. CONCLUSIONS Patients seen via telehealth during COVID-19 reported levels of satisfaction similar to those seen in-office the year prior. These telehealth satisfaction levels, however, are contextualized within the expected confines of a pandemic. Further research is required to determine whether satisfaction remains consistent as telemedicine becomes a ubiquitous component of medical practice.
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Affiliation(s)
| | - Anni Wong
- Department of Otolaryngology, Icahn
School of Medicine at Mount Sinai, New York, NY, USA
| | - Sunder Gidumal
- Department of Otolaryngology, Icahn
School of Medicine at Mount Sinai, New York, NY, USA
| | - Janki Shah
- Department of Otolaryngology, Icahn
School of Medicine at Mount Sinai, New York, NY, USA
| | - Peter Filip
- Department of Otolaryngology, Icahn
School of Medicine at Mount Sinai, New York, NY, USA
| | - Aisosa Omorogbe
- Department of Otolaryngology, Icahn
School of Medicine at Mount Sinai, New York, NY, USA
| | - Joshua Rosenberg
- Department of Otolaryngology, Icahn
School of Medicine at Mount Sinai, New York, NY, USA
| | - Satish Govindaraj
- Department of Otolaryngology, Icahn
School of Medicine at Mount Sinai, New York, NY, USA
| | - Alfred-Marc Iloreta
- Department of Otolaryngology, Icahn
School of Medicine at Mount Sinai, New York, NY, USA
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8
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Brimioulle M, Arih I, Pervaiz A, Patel W, Davies A, Sekyi-Djan M, Qureishi A, Chaidas K. The role of telephone clinics in ENT. J Laryngol Otol 2023; 137:914-920. [PMID: 36751912 DOI: 10.1017/s0022215123000129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
OBJECTIVE This quality improvement project assessed the outcomes of telephone consultations for ENT patients in order to identify areas where telephone consultations may be useful in the long term. METHOD New ENT patient appointments in May 2019 and May 2020 were reviewed. Total outcomes as well as subspecialty-specific and presentation-specific outcomes were compared for telephone versus face-to-face consultations. RESULTS There were 638 consultations in total (465 in 2019 and 173 in 2020). Following telephone consultations, more patients were followed up and fewer patients were listed for surgery or discharged. Overall outcomes for subspecialties followed the general trend, albeit with a few variations. CONCLUSION Lack of clinical examination in telephone consultations likely affects confidence in making a diagnosis and therefore discharging or listing patients for surgery. Nevertheless, looking at specialty-specific and presentation-specific data, there may be a role for telephone consultations in selected patients.
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Affiliation(s)
- M Brimioulle
- ENT Department, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - I Arih
- ENT Department, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - A Pervaiz
- ENT Department, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - W Patel
- ENT Department, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - A Davies
- ENT Department, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - M Sekyi-Djan
- ENT Department, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - A Qureishi
- ENT Department, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - K Chaidas
- ENT Department, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Shields C, Sladen M, Bruce IA, Kluk K, Nichani J. Exploring the Correlations Between Measures of Listening Effort in Adults and Children: A Systematic Review with Narrative Synthesis. Trends Hear 2023; 27:23312165221137116. [PMID: 36636020 PMCID: PMC9982391 DOI: 10.1177/23312165221137116] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Listening effort (LE) describes the cognitive resources needed to process an auditory message. Our understanding of this notion remains in its infancy, hindering our ability to appreciate how it impacts individuals with hearing impairment effectively. Despite the myriad of proposed measurement tools, a validated method remains elusive. This is complicated by the seeming lack of association between tools demonstrated via correlational analyses. This review aims to systematically review the literature relating to the correlational analyses between different measures of LE. Five databases were used- PubMed, Cochrane, EMBASE, PsychINFO, and CINAHL. The quality of the evidence was assessed using the GRADE criteria and risk of bias with ROBINS-I/GRADE tools. Each statistically significant analysis was classified using an approved system for medical correlations. The final analyses included 48 papers, equating to 274 correlational analyses, of which 99 reached statistical significance (36.1%). Within these results, the most prevalent classifications were poor or fair. Moreover, when moderate or very strong correlations were observed, they tended to be dependent on experimental conditions. The quality of evidence was graded as very low. These results show that measures of LE are poorly correlated and supports the multi-dimensional concept of LE. The lack of association may be explained by considering where each measure operates along the effort perception pathway. Moreover, the fragility of significant correlations to specific conditions further diminishes the hope of finding an all-encompassing tool. Therefore, it may be prudent to focus on capturing the consequences of LE rather than the notion itself.
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Affiliation(s)
- Callum Shields
- ENT department, Royal Manchester
Children's Hospital, Manchester, UK,University of Manchester, Manchester, UK,Callum Shields, ENT department, Royal
Manchester Children's Hospital, Manchester, UK.
| | - Mark Sladen
- ENT department, Royal Manchester
Children's Hospital, Manchester, UK
| | | | | | - Jaya Nichani
- ENT department, Royal Manchester
Children's Hospital, Manchester, UK
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Xie KZ, Gottlich HC, Antezana LA, Yeakel S, Nassiri AM, Moore EJ, Carlson ML. Experience with Telemedicine in a Tertiary Academic Otologic Clinic During the COVID-19 Pandemic. Otol Neurotol 2023; 44:72-80. [PMID: 36509445 PMCID: PMC9762615 DOI: 10.1097/mao.0000000000003755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To examine the utility of telemedicine in a tertiary otologic practice. STUDY DESIGN Retrospective case series. SETTING Tertiary neurotology clinic. PATIENTS Consecutive adult patients presenting via video visit between January 2020 and January 2021. INTERVENTIONS Televideo modality to conduct visits with patients seeking evaluation for new concerns, second opinions, or routine follow-up for established conditions. MAIN OUTCOME MEASURES Success of the televideo visit defined by the televideo visit being sufficient for determining a definitive plan and not requiring deferment of recommendations for a subsequent in-person visit. RESULTS A total of 102 televideo visits were performed among 100 unique patients. Of those, 92 (90.2%) visits were for second opinions or evaluation of new concerns, most commonly for vestibular schwannoma (n = 32, 31.4%), followed by sensorineural hearing loss (n = 20, 19.6%). Other visits were conducted for early postoperative follow-up and established general follow-up. In 91.2% of cases (n = 93), patients were successfully evaluated and provided recommendations from the initial video visit. All visits with patients having a diagnosis of meningioma (n = 7), and nearly all with vestibular Schwannoma (97%, n = 31) and sensorineural hearing loss (95%, n = 19) were successful. Of the 79 patients offered surgery as one potential treatment option, 31 patients underwent surgery at our institution by time of review. Patients with unsuccessful visits (n = 9, 8.8%) were advised to schedule additional in-person diagnostic imaging, vestibular testing, or cochlear implant candidacy evaluation to establish a more definitive care plan. CONCLUSION Virtual televideo visits were successful for a high percentage of selected patients seen at a tertiary neurotology practice, particularly those seeking evaluation of vestibular schwannoma or sensorineural hearing loss.
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Affiliation(s)
| | | | | | - Sarah Yeakel
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Ashley M. Nassiri
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Eric J. Moore
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Matthew L. Carlson
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
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11
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Williams HE, Aiyar L, Dinulos MB, Flannery D, McClure ML, Lloyd-Puryear MA, Sanghavi K, Trotter TL, Viskochil D. Considerations for policymakers for improving health care through telegenetics: A points to consider statement of the American College of Medical Genetics and Genomics (ACMG). Genet Med 2022; 24:2211-2219. [PMID: 36040445 DOI: 10.1016/j.gim.2022.07.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- Heather E Williams
- Department of Pathology and Cell Biology, Columbia University, New York, NY; School of Management, Yale University, New Haven, CT
| | - Lila Aiyar
- Genomics Section, Hawaii Department of Health, Honolulu, HI
| | - Mary Beth Dinulos
- Departments of Pediatrics and Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - David Flannery
- Center for Personalized Genetic Healthcare, Cleveland Clinic, Cleveland, OH
| | | | - Michele A Lloyd-Puryear
- Retired from Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Kunal Sanghavi
- The Jackson Laboratory for Genomic Medicine, The Jackson Laboratory, Farmington, CT
| | - Tracy L Trotter
- Department of Pediatrics, John Muir Health, San Francisco, CA
| | - David Viskochil
- Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, UT
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- American College of Medical Genetics and Genomics, Bethesda, MD
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12
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Patel R, Fang CH, Grube JG, Eloy JA, Hsueh WD. COVID-19 and rhinological surgery. OPERATIVE TECHNIQUES IN OTOLARYNGOLOGY--HEAD AND NECK SURGERY 2022; 33:103-111. [PMID: 35502266 PMCID: PMC9046134 DOI: 10.1016/j.otot.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The Coronavirus-19 (COVID-19) pandemic has caused disruptions in the normal patient care workflow, necessitating adaptations within the healthcare profession. The objective of this article is to outline some of these adaptations and considerations necessitated by COVID-19 within the subspeciality of rhinology and endoscopic skull base surgery.
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Affiliation(s)
- Rushi Patel
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Christina H Fang
- Department of Otorhinolaryngology - Head and Neck Surgery, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, New York
| | - Jordon G Grube
- Division of Otolaryngology, Albany Medical College, Albany, New York
| | - Jean Anderson Eloy
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
- Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
- Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey
- Department of Otolaryngology and Facial Plastic Surgery, Saint Barnabas Medical Center - RWJ Barnabas Health, Livingston, New Jersey
| | - Wayne D Hsueh
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
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13
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Fang CH, Smith RV. COVID-19 and the resurgence of telehealth in otolaryngology. OPERATIVE TECHNIQUES IN OTOLARYNGOLOGY-HEAD AND NECK SURGERY 2022; 33:158-164. [PMID: 35505953 PMCID: PMC9047697 DOI: 10.1016/j.otot.2022.04.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The objective of this review is to examine the impact of the ongoing Coronavirus disease 2019 (COVID-19) pandemic on the use of telehealth in Otolaryngology. The use of telemedicine rose dramatically during the pandemic to meet the need for continued patient care while allowing for physical separation of providers and patients. Telemedicine has been used to evaluate patients with a variety of pathologies including dysphonia, vertigo, and anosmia. Innovative use of at-home exams, such as video-otoscopy has aided providers in overcoming challenges associated with a highly specialized physical exam. The use of telemedicine in Otolaryngology will likely remain essential in the post-pandemic era and has promising results for improving clinical efficiency.
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Affiliation(s)
- Christina H Fang
- Department of Otorhinolaryngology, Head and Neck Surgery, Montefiore Medical Center, The University Hospital of Albert Einstein College of Medicine, Bronx, New York
| | - Richard V Smith
- Department of Otorhinolaryngology, Head and Neck Surgery, Montefiore Medical Center, The University Hospital of Albert Einstein College of Medicine, Bronx, New York
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Taha BA, Al-Jubouri Q, Al Mashhadany Y, Zan MSDB, Bakar AAA, Fadhel MM, Arsad N. Photonics enabled intelligence system to identify SARS-CoV 2 mutations. Appl Microbiol Biotechnol 2022; 106:3321-3336. [PMID: 35484414 PMCID: PMC9050350 DOI: 10.1007/s00253-022-11930-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/10/2022] [Accepted: 04/12/2022] [Indexed: 12/13/2022]
Abstract
Abstract The COVID-19, MERS-CoV, and SARS-CoV are hazardous epidemics that have resulted in many deaths which caused a worldwide debate. Despite control efforts, SARS-CoV-2 continues to spread, and the fast spread of this highly infectious illness has posed a grave threat to global health. The effect of the SARS-CoV-2 mutation, on the other hand, has been characterized by worrying variations that modify viral characteristics in response to the changing resistance profile of the human population. The repeated transmission of virus mutation indicates that epidemics are likely to occur. Therefore, an early identification system of ongoing mutations of SARS-CoV-2 will provide essential insights for planning and avoiding future outbreaks. This article discussed the following highlights: First, comparing the omicron mutation with other variants; second, analysis and evaluation of the spread rate of the SARS-CoV 2 variations in the countries; third, identification of mutation areas in spike protein; and fourth, it discussed the photonics approaches enabled with artificial intelligence. Therefore, our goal is to identify the SARS-CoV 2 virus directly without the need for sample preparation or molecular amplification procedures. Furthermore, by connecting through the optical network, the COVID-19 test becomes a component of the Internet of healthcare things to improve precision, service efficiency, and flexibility and provide greater availability for the evaluation of the general population. Key points • A proposed framework of photonics based on AI for identifying and sorting SARS-CoV 2 mutations. • Comparative scatter rates Omicron variant and other SARS-CoV 2 variations per country. • Evaluating mutation areas in spike protein and AI enabled by photonic technologies for SARS-CoV 2 virus detection.
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Affiliation(s)
- Bakr Ahmed Taha
- UKM-Department of Electrical, Electronic and Systems Engineering, Faculty of Engineering and Built Environment, Universiti Kebangsaan Malaysia, 43600, UKM Bangi, Malaysia
| | - Qussay Al-Jubouri
- Department of Communication Engineering, University of Technology, Baghdad, 00964, Iraq
| | - Yousif Al Mashhadany
- Department of Electrical Engineering, College of Engineering, University of Anbar, Anbar, 00964, Iraq
| | - Mohd Saiful Dzulkefly Bin Zan
- UKM-Department of Electrical, Electronic and Systems Engineering, Faculty of Engineering and Built Environment, Universiti Kebangsaan Malaysia, 43600, UKM Bangi, Malaysia
| | - Ahmad Ashrif A Bakar
- UKM-Department of Electrical, Electronic and Systems Engineering, Faculty of Engineering and Built Environment, Universiti Kebangsaan Malaysia, 43600, UKM Bangi, Malaysia
| | - Mahmoud Muhanad Fadhel
- UKM-Department of Electrical, Electronic and Systems Engineering, Faculty of Engineering and Built Environment, Universiti Kebangsaan Malaysia, 43600, UKM Bangi, Malaysia
| | - Norhana Arsad
- UKM-Department of Electrical, Electronic and Systems Engineering, Faculty of Engineering and Built Environment, Universiti Kebangsaan Malaysia, 43600, UKM Bangi, Malaysia.
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Robiony M, Sembronio S, Tel A, Ocello E, Antonio JK, Graziadio M, Miani C. Clinical signs, telemedicine and online consultations in head and neck diseases during the SARS CoV-2 pandemic: an Italian experience. ACTA OTORHINOLARYNGOLOGICA ITALICA 2022; 42:S36-S45. [PMID: 35763273 PMCID: PMC9137386 DOI: 10.14639/0392-100x-suppl.1-42-2022-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 02/17/2022] [Indexed: 11/23/2022]
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Pediatric otolaryngology telemedicine amid a pandemic - And beyond. Int J Pediatr Otorhinolaryngol 2022; 153:111014. [PMID: 34974276 PMCID: PMC8713418 DOI: 10.1016/j.ijporl.2021.111014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 11/05/2021] [Accepted: 12/25/2021] [Indexed: 01/20/2023]
Abstract
INTRODUCTION The coronavirus disease of 2019 (COVID-19) pandemic catalyzed an unprecedented redesign and innovative overhaul of health care delivery thrusting from fringe to mainstream virtual care. With a return to conventional practice, we now must create a research and policy agenda using the changes wrought by COVID-19 to help create a better health care system in its aftermath. The purpose of this study was to assess satisfaction of otolaryngology outpatient visits during the pandemic. METHODS A prospective survey study was performed on caregivers of all patients ages 0-26 years old seen in the Division of Pediatric Otolaryngology at our large tertiary care children's hospital from February-April 2020. The three study groups were those seen in-person 6 weeks before telemedicine was implemented (IBTM), those seen in telemedicine during the first 6 weeks (TM) it was implemented at our hospital, and those seen in-person during the telemedicine period (IDTM) in the same timeframe. The survey consisted of satisfaction questions related to their visit, if their child was recommended surgery at the time of the visit, and if the caregiver agreed with the recommendation. A medical record review was also performed. RESULTS A total of 176 caregivers completed the survey with 113(64.2%) completing the survey for an IBTM appointment, 59(33.5%) for a TM appointment, and 4(2.3%) for an IDTM appointment. There were 100(56.8%) male patients and 167(94.9%) were white. Families gave a higher response for the statement "The ability to communicate with the physician" (p = .012) and "The overall outpatient experience" (p = .004) in the IBTM cohort compared to the TM group. There were no significant differences for the other statements regarding the ability to understand recommendations, courtesy, and knowledge of the physician. Regardless of group, 98.6% of caregivers agreed with surgical recommendation when surgery was recommended. However, when surgery was not recommended at the appointment, caregivers were 11x more likely to disagree with the surgical recommendations, OR:11.49,95%CI:1.44-91.38,p = .005. CONCLUSION We conclude that telemedicine was equally well received by patients as compared to traditional live assessments suggesting that virtual care is a viable post-pandemic paradigm change. Satisfaction was rated as "Good" or "Excellent", however, messaging when surgery is not recommended was less acceptable and must be improved to obtain increased caregivers' agreement in an era of shared decision making.
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Eligibility for live, interactive otolaryngology telemedicine: 19-month experience before and during the COVID-19 pandemic in Taiwan. Biomed J 2021; 44:582-588. [PMID: 34371224 PMCID: PMC8556875 DOI: 10.1016/j.bj.2021.07.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 07/19/2021] [Accepted: 07/29/2021] [Indexed: 01/27/2023] Open
Abstract
Background Unequal access to healthcare is a global medical problem. Telemedicine, recently made possible by technological advances, may mitigate this inequity. However, the usefulness of telemedicine for procedure-driven disciplines, such as otolaryngology, under infectious conditions (e.g., the COVID-19 pandemic) is unknown. Methods Telemedicine was made legal in Taiwan by an amendment to the Physician Act in 2018. Kaohsiung Chang Gung Memorial Hospital was the first hospital in Taiwan to provide the telemedicine service by connecting to the Chenggong Branch of Taitung Hospital (CGBTH) in November 2018. This retrospective cohort study included all new and established otolaryngology outpatient consultations between November 2018 and May 2020 at CGBTH. The Current Procedural Terminology and International Classification of Disease, 10th Revision codes, patient demographic data, and questionnaire data were obtained. Results The study included 123 patients with 218 encounters over 19 months. The majority of complaints were ear-related (52.6%). Overall, 49% of the encounters required a specialized procedure for diagnosis and treatment; of these, cerumen removal was the most common procedure. The patient subjective improvement rate increased over the study period (from 62.0% to 78.9%). The rates of return and case closure were both around 90% in 2018 and 2019. The number of otolaryngology consultations and rate of return declined after the start of the COVID-19 pandemic; however, the subjective improvement and case closure rates remained stable. The telemedicine service saved at least 2 h driving time per visit. Conclusion Telemedicine for otolaryngology is a promising approach for remote and underserved regions, as well as during an infectious disease pandemic.
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Dai Z, Wang Y, Hang C, Zhu K, Meng X. Telemedicine for ear diseases with the smartphone otoscopes via WeChat in the COVID-19 era. Am J Otolaryngol 2021; 42:102997. [PMID: 33770717 DOI: 10.1016/j.amjoto.2021.102997] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 02/16/2021] [Accepted: 03/15/2021] [Indexed: 12/30/2022]
Abstract
PURPOSE This study aimed to evaluate the outcomes and satisfaction of ear patients who participated in the smartphone otoscopes telemedicine via WeChat. METHODS Patients in this study included newly diagnosed outpatients and online patients who did not undergo an outpatient diagnosis. Patients performed regular ear self-examinations, took pictures at home using their smartphone endoscopes, and submitted images to a WeChat community. Otolaryngologist gave timely online feedback. All of the following data were recorded: patients age and gender, disease duration, outpatient diagnosis, side, telemedicine duration, number of telemedicine visits, outcomes, satisfaction. RESULTS A total of 74 patients were included in the study, including 39 males and 35 females, with an average age of 31.1 ± 13.7 years (range 4-55 years). Of these patients, 68 were outpatients, and 6 directly participated in telemedicine online. The patient's disease duration ranged from 1 day to 15 days, with an average of 4.0 ± 3.0 days. The mean duration was 8.1 days (range: 3-21 days) for telemedicine. The mean number of visits was 2.7 times (range: 2-6 times) for telemedicine. 68 (91.9%) of the 74 patients were cured, 6 (8.1%) were improved, and 0 (0%) were ineffective. Almost all patients were pleased with the telemedicine service, 71.9 0% were very satisfied (n = 62), 28.10% were very satisfied (n = 11), and 0% were dissatisfied (n = 0). CONCLUSIONS Smartphone otoscopes telemedicine can decrease outpatient follow-up, reduce the risk of cross-infection, increase telemedicine accuracy, and improve patient satisfaction. It is worthy of clinical application in the COVID-19 era.
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Detection of COVID-19 Virus on Surfaces Using Photonics: Challenges and Perspectives. Diagnostics (Basel) 2021. [PMID: 34205401 DOI: 10.3390/diagnostics11061119.(] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
The propagation of viruses has become a global threat as proven through the coronavirus disease (COVID-19) pandemic. Therefore, the quick detection of viral diseases and infections could be necessary. This study aims to develop a framework for virus diagnoses based on integrating photonics technology with artificial intelligence to enhance healthcare in public areas, marketplaces, hospitals, and airfields due to the distinct spectral signatures from lasers' effectiveness in the classification and monitoring of viruses. However, providing insights into the technical aspect also helps researchers identify the possibilities and difficulties in this field. The contents of this study were collected from six authoritative databases: Web of Science, IEEE Xplore, Science Direct, Scopus, PubMed Central, and Google Scholar. This review includes an analysis and summary of laser techniques to diagnose COVID-19 such as fluorescence methods, surface-enhanced Raman scattering, surface plasmon resonance, and integration of Raman scattering with SPR techniques. Finally, we select the best strategies that could potentially be the most effective methods of reducing epidemic spreading and improving healthcare in the environment.
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Taha BA, Al Mashhadany Y, Bachok NN, Ashrif A Bakar A, Hafiz Mokhtar MH, Dzulkefly Bin Zan MS, Arsad N. Detection of COVID-19 Virus on Surfaces Using Photonics: Challenges and Perspectives. Diagnostics (Basel) 2021; 11:1119. [PMID: 34205401 PMCID: PMC8234865 DOI: 10.3390/diagnostics11061119] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/18/2021] [Accepted: 06/18/2021] [Indexed: 02/07/2023] Open
Abstract
The propagation of viruses has become a global threat as proven through the coronavirus disease (COVID-19) pandemic. Therefore, the quick detection of viral diseases and infections could be necessary. This study aims to develop a framework for virus diagnoses based on integrating photonics technology with artificial intelligence to enhance healthcare in public areas, marketplaces, hospitals, and airfields due to the distinct spectral signatures from lasers' effectiveness in the classification and monitoring of viruses. However, providing insights into the technical aspect also helps researchers identify the possibilities and difficulties in this field. The contents of this study were collected from six authoritative databases: Web of Science, IEEE Xplore, Science Direct, Scopus, PubMed Central, and Google Scholar. This review includes an analysis and summary of laser techniques to diagnose COVID-19 such as fluorescence methods, surface-enhanced Raman scattering, surface plasmon resonance, and integration of Raman scattering with SPR techniques. Finally, we select the best strategies that could potentially be the most effective methods of reducing epidemic spreading and improving healthcare in the environment.
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Affiliation(s)
- Bakr Ahmed Taha
- UKM—Department of Electrical, Electronic and Systems Engineering, Faculty of Engineering and Built Environment, Universiti Kebangsaan Malaysia, UKM Bangi 43600, Malaysia; (B.A.T.); (N.N.B.); (A.A.A.B.); (M.H.H.M.); (M.S.D.B.Z.)
| | - Yousif Al Mashhadany
- Department of Electrical Engineering, College of Engineering, University of Anbar, Anbar 00964, Iraq;
| | - Nur Nadia Bachok
- UKM—Department of Electrical, Electronic and Systems Engineering, Faculty of Engineering and Built Environment, Universiti Kebangsaan Malaysia, UKM Bangi 43600, Malaysia; (B.A.T.); (N.N.B.); (A.A.A.B.); (M.H.H.M.); (M.S.D.B.Z.)
| | - Ahmad Ashrif A Bakar
- UKM—Department of Electrical, Electronic and Systems Engineering, Faculty of Engineering and Built Environment, Universiti Kebangsaan Malaysia, UKM Bangi 43600, Malaysia; (B.A.T.); (N.N.B.); (A.A.A.B.); (M.H.H.M.); (M.S.D.B.Z.)
| | - Mohd Hadri Hafiz Mokhtar
- UKM—Department of Electrical, Electronic and Systems Engineering, Faculty of Engineering and Built Environment, Universiti Kebangsaan Malaysia, UKM Bangi 43600, Malaysia; (B.A.T.); (N.N.B.); (A.A.A.B.); (M.H.H.M.); (M.S.D.B.Z.)
| | - Mohd Saiful Dzulkefly Bin Zan
- UKM—Department of Electrical, Electronic and Systems Engineering, Faculty of Engineering and Built Environment, Universiti Kebangsaan Malaysia, UKM Bangi 43600, Malaysia; (B.A.T.); (N.N.B.); (A.A.A.B.); (M.H.H.M.); (M.S.D.B.Z.)
| | - Norhana Arsad
- UKM—Department of Electrical, Electronic and Systems Engineering, Faculty of Engineering and Built Environment, Universiti Kebangsaan Malaysia, UKM Bangi 43600, Malaysia; (B.A.T.); (N.N.B.); (A.A.A.B.); (M.H.H.M.); (M.S.D.B.Z.)
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