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Sánchez-Machín I, Poza-Guedes P, Mederos-Luis E, González-Pérez R. The paradigm shift in allergy consultations through a digital ecosystem. Front Digit Health 2024; 6:1402810. [PMID: 38725446 PMCID: PMC11079116 DOI: 10.3389/fdgth.2024.1402810] [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: 03/18/2024] [Accepted: 04/12/2024] [Indexed: 05/12/2024] Open
Abstract
In Spain, specialist outpatient care traditionally relied on in-person consultations at public hospitals, leading to long wait times and limited clinical analysis in appointment assignments. However, the emergence of Information and Communication Technologies (ICTs) has transformed patient care, creating a seamless healthcare ecosystem. At the Allergy Department, we aimed to share our experience in transitioning form a traditional linear model of patient flow across different healthcare levels to the implementation of a digital ecosystem. By telemedicine, we can prioritize individuals based on clinical relevance, promptly and efficiently addressing potentially life-threatening conditions such as severe uncontrolled asthma or hymenoptera venom anaphylaxis. Furthermore, our adoption of telephone consultations has markedly reduced the need for in-person hospital visits, while issues with unstable patients are swiftly addressed via WhatsApp. This innovative approach not only enhances efficiency but also facilitates the dissemination of personalized medical information through various channels, contributing to public awareness and education, particularly regarding allergies. Concerns related to confidentiality, data privacy, and the necessity for informed consent must thoroughly be addressed. Also, to ensure the success of ICT integration, it is imperative to focus on the quality of educational information, its efficient dissemination, and anticipate potential unforeseen consequences. Sharing experiences across diverse health frameworks and medical specialties becomes crucial in refining these processes, drawing insights from the collective experiences of others. This collaborative effort aims to contribute to the ongoing development of a more effective and sustainable healthcare system.
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Affiliation(s)
| | - Paloma Poza-Guedes
- Allergy Department, Canary Islands University Hospital, Santa Cruz de Tenerife, Spain
- Severe Asthma Unit, Canary Islands University Hospital, Santa Cruz de Tenerife, Spain
| | - Elena Mederos-Luis
- Allergy Department, Canary Islands University Hospital, Santa Cruz de Tenerife, Spain
| | - Ruperto González-Pérez
- Allergy Department, Canary Islands University Hospital, Santa Cruz de Tenerife, Spain
- Severe Asthma Unit, Canary Islands University Hospital, Santa Cruz de Tenerife, Spain
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2
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Smolinska S, Popescu FD, Izquierdo E, Antolín-Amérigo D, Price OJ, Alvarez-Perea A, Eguíluz Gracia I, Papadopoulos NG, Pfaar O, Fassio F, Hoffmann-Sommergruber K, Dramburg S, Agache I, Jutel M, Brough HA, Fonseca JA, Angier E, Boccabella C, Bonini M, Dunn Galvin A, Gibson PG, Gawlik R, Hannachi F, Kalayci Ö, Klimek L, Knibb R, Matricardi P, Chivato T. Telemedicine with special focus on allergic diseases and asthma-Status 2022: An EAACI position paper. Allergy 2024; 79:777-792. [PMID: 38041429 DOI: 10.1111/all.15964] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 10/31/2023] [Accepted: 11/08/2023] [Indexed: 12/03/2023]
Abstract
Efficacious, effective and efficient communication between healthcare professionals (HCP) and patients is essential to achieve a successful therapeutic alliance. Telemedicine (TM) has been used for decades but during the COVID-19 pandemic its use has become widespread. This position paper aims to describe the terminology and most important forms of TM among HCP and patients and review the existing studies on the uses of TM for asthma and allergy. Besides, the advantages and risks of TM are discussed, concluding that TM application reduces costs and time for both, HCP and patients, but cannot completely replace face-to-face visits for physical examinations and certain tests that are critical in asthma and allergy. From an ethical point of view, it is important to identify those involved in the TM process, ensure confidentiality and use communication channels that fully guarantee the security of the information. Unmet needs and directions for the future regarding implementation, data protection, privacy regulations, methodology and efficacy are described.
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Affiliation(s)
- Sylwia Smolinska
- Department of Clinical Immunology, Wroclaw Medical University, Wroclaw, Poland
| | - Florin-Dan Popescu
- Department of Allergology, Nicolae Malaxa Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Elena Izquierdo
- Department of Basic Medical Sciences, Facultad de Medicina, Institute of Applied Molecular Medicine Instituto de Medicina Molecular Aplicada Nemesio Díez (IMMA), Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, Madrid, Spain
| | - Darío Antolín-Amérigo
- Servicio de Alergia, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Oliver J Price
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, UK
| | - Alberto Alvarez-Perea
- Allergy Service, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Gregorio Marañón Health Research Institute, Madrid, Spain
| | - Ibon Eguíluz Gracia
- Allergy Department, Hospital Regional Universitario de Malaga and Allergy Research Group, Instituto de Investigacion Biomedica de Malaga (IBIMA-Plataforma BIONAND). RICORS "Inflammatory Diseases", Malaga, Spain
| | - Nikolaos G Papadopoulos
- Allergy Department, 2nd Pediatric Clinic, National Kapodistrian University of Athens, Athens, Greece
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
| | | | | | - Stephanie Dramburg
- Department of Pediatric Respiratory Care, Immunology and Intensive Care Medicine, Charité Universitätsmedizin, Berlin, Germany
| | - Ioana Agache
- Allergy and Clinical Immunology at Transylvania University, Brasov, Romania
| | - Marek Jutel
- Department of Clinical Immunology, Wroclaw Medical University, Wroclaw, Poland
- "ALL-MED" Medical Research Institute, Wroclaw, Poland
| | - Helen A Brough
- Children's Allergy Service, Evelina Children's Hospital, Guy's and St. Thomas' Hospital, London, UK
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - João A Fonseca
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Elizabeth Angier
- Primary Care, Population Science and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Cristina Boccabella
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Matteo Bonini
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Clinical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
- National Heart and Lung Institute (NHLI), Imperial College London, London, UK
| | | | - Peter G Gibson
- John Hunter Hospital, Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia
| | - Radoslaw Gawlik
- Department of Internal Medicine, Allergology and Clinical Immunology, Medical University of Silesia, Katowice, Poland
| | - Farah Hannachi
- Immuno-Allergology Unit, Hospital Centre of Luxembourg, Luxembourg City, Luxembourg
| | - Ömer Kalayci
- Hacettepe University School of Medicine, Ankara, Turkey
| | - Ludger Klimek
- Center for Rhinology and Allergology, Wiesbaden, Germany
| | - Rebecca Knibb
- School of Psychology, College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Paolo Matricardi
- Department of Pediatric Respiratory Care, Immunology and Intensive Care Medicine, Charité Universitätsmedizin, Berlin, Germany
| | - Tomás Chivato
- Department of Clinical Medical Sciences, Facultad de Medicina, Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, Madrid, Spain
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3
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He T, Cui W, Feng Y, Li X, Yu G. Digital health integration for noncommunicable diseases: Comprehensive process mapping for full-life-cycle management. J Evid Based Med 2024; 17:26-36. [PMID: 38361398 DOI: 10.1111/jebm.12583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/05/2024] [Indexed: 02/17/2024]
Abstract
AIM To create a systematic digital health process mapping framework for full-life-cycle noncommunicable disease management grounded in key stakeholder engagement. METHODS A triphasic, qualitative methodology was employed to construct a process mapping framework for digital noncommunicable disease management in Shanghai, China. The first phase involved desk research to examine current guidance and practices. In the second phase, pivotal stakeholders participated in focus group discussions to identify prevalent digital touchpoints across lifetime noncommunicable disease management. In the final phase, the Delphi technique was used to refine the framework based on expert insights and obtain consensus. RESULTS We identified 60 digital touchpoints across five essential stages of full-life-cycle noncommunicable disease management. Most experts acknowledged the rationality and feasibility of these touchpoints. CONCLUSIONS This study led to the creation of a comprehensive digital health process mapping framework that encompasses the entire life cycle of noncommunicable disease management. The insights gained emphasize the importance of a systemic strategic, person-centered approach over a fragmented, purely technocentric approach. We recommend that healthcare professionals use this framework as a linchpin for efficient disease management and seamless technology incorporation in clinical practice.
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Affiliation(s)
- Tianrui He
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenbin Cui
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuxuan Feng
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xingyi Li
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guangjun Yu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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4
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Aggelidis X, Kritikou M, Makris M, Miligkos M, Papapostolou N, Papadopoulos NG, Xepapadaki P. Tele-Monitoring Applications in Respiratory Allergy. J Clin Med 2024; 13:898. [PMID: 38337592 PMCID: PMC10856055 DOI: 10.3390/jcm13030898] [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: 01/10/2024] [Revised: 01/26/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
Respiratory allergic diseases affect over 500 million people globally and pose a substantial burden in terms of morbidity, mortality, and healthcare costs. Restrictive factors such as geographical disparities, infectious pandemics, limitations in resources, and shortages of allergy specialists in underserved areas impede effective management. Telemedicine encompasses real-time visits, store-and-forward option triage, and computer-based technologies for establishing efficient doctor-patient communication. Recent advances in digital technology, including designated applications, informative materials, digital examination devices, wearables, digital inhalers, and integrated platforms, facilitate personalized and evidence-based care delivery. The integration of telemonitoring in respiratory allergy care has shown beneficial effects on disease control, adherence, and quality of life. While the COVID-19 pandemic accelerated the adoption of telemedicine, certain concerns regarding technical requirements, platform quality, safety, reimbursement, and regulatory considerations remain unresolved. The integration of artificial intelligence (AI) in telemonitoring applications holds promise for data analysis, pattern recognition, and personalized treatment plans. Striking the balance between AI-enabled insights and human expertise is crucial for optimizing the benefits of telemonitoring. While telemonitoring exhibits potential for enhancing patient care and healthcare delivery, critical considerations have to be addressed in order to ensure the successful integration of telemonitoring into the healthcare landscape.
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Affiliation(s)
- Xenofon Aggelidis
- Allergy Unit, 2nd Department of Dermatology and Venereology, Medical School, Attikon University Hospital, National and Kapodistrian University of Athens, 15772 Athens, Greece; (X.A.); (M.M.); (N.P.)
| | - Maria Kritikou
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, 15772 Athens, Greece; (M.M.); (N.G.P.); (P.X.)
| | - Michael Makris
- Allergy Unit, 2nd Department of Dermatology and Venereology, Medical School, Attikon University Hospital, National and Kapodistrian University of Athens, 15772 Athens, Greece; (X.A.); (M.M.); (N.P.)
| | - Michael Miligkos
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, 15772 Athens, Greece; (M.M.); (N.G.P.); (P.X.)
| | - Niki Papapostolou
- Allergy Unit, 2nd Department of Dermatology and Venereology, Medical School, Attikon University Hospital, National and Kapodistrian University of Athens, 15772 Athens, Greece; (X.A.); (M.M.); (N.P.)
| | - Nikolaos G. Papadopoulos
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, 15772 Athens, Greece; (M.M.); (N.G.P.); (P.X.)
| | - Paraskevi Xepapadaki
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, 15772 Athens, Greece; (M.M.); (N.G.P.); (P.X.)
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Pappalardo AA, Codispoti CD, Mahdavinia M. Health care access in allergy and immunology: Problems and potential solutions. J Allergy Clin Immunol 2024; 153:401-403. [PMID: 37926120 DOI: 10.1016/j.jaci.2023.10.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 10/19/2023] [Accepted: 10/24/2023] [Indexed: 11/07/2023]
Affiliation(s)
- Andrea A Pappalardo
- Department of Internal Medicine, University of Illinois Chicago, Chicago, Ill; Department of Pediatrics, University of Illinois Chicago, Chicago, Ill
| | - Christopher D Codispoti
- Department of Internal Medicine, Rush University Medical Center, Chicago, Ill; Department of Pediatrics, Rush University Medical Center, Chicago, Ill.
| | - Mahboobeh Mahdavinia
- Department of Internal Medicine, Rush University Medical Center, Chicago, Ill; Department of Pediatrics, Rush University Medical Center, Chicago, Ill
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Pongdee T, Brunner WM, Kanuga MJ, Sussman JH, Wi CI, Juhn YJ. Rural Health Disparities in Allergy, Asthma, and Immunologic Diseases: The Current State and Future Direction for Clinical Care and Research. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:334-344. [PMID: 38013156 PMCID: PMC11089647 DOI: 10.1016/j.jaip.2023.11.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/06/2023] [Accepted: 11/08/2023] [Indexed: 11/29/2023]
Abstract
Rural health disparities are well documented and continue to jeopardize the long-term health and wellness for the millions of individuals who live in rural America. The disparities observed between urban and rural residents encompass numerous morbidity and mortality measures for several chronic diseases and have been referred to as the "rural mortality penalty." Although the unmet health needs of rural communities are widely acknowledged, little is known about rural health disparities in allergies, asthma, and immunologic diseases. Furthermore, the intersection between rural health disparities and social determinants of health has not been fully explored. To achieve a more complete understanding of the factors that perpetuate rural health disparities, greater research efforts followed by improved practice and policy are needed that account for the complex social context within rural communities rather than a general comparison between urban and rural environments or focusing on biomedical factors. Moreover, research efforts must prioritize community inclusion throughout rural areas through meaningful engagement of stakeholders in both clinical care and research. In this review, we examine the scope of health disparities in the rural United States and the impact of social determinants of health. We then detail the current state of rural health disparities in the field of allergy, asthma, and immunology. To close, we offer future considerations to address knowledge gaps and unmet needs for both clinical care and research in addressing rural health disparities.
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Affiliation(s)
- Thanai Pongdee
- Division of Allergic Diseases, Mayo Clinic, Rochester, Minn.
| | - Wendy M Brunner
- Center for Rural Community Health, Bassett Research Institute, Bassett Medical Center, Cooperstown, NY
| | - Mansi J Kanuga
- Division of Allergic Diseases, Mayo Clinic Health System, Red Wing, Minn
| | | | - Chung-Il Wi
- Precision Population Science Lab, Mayo Clinic, Rochester, Minn; Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minn
| | - Young J Juhn
- Precision Population Science Lab, Mayo Clinic, Rochester, Minn; Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minn; Office of Mayo Clinic Health System Research, Mayo Clinic Health System, Rochester, Minn.
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Allenbrand R, DiDonna A, Marshall J, Kennedy K. Establishing a Virtual Home Assessment Program: from Concept to Implementation as a Result of the COVID-19 Pandemic. Curr Allergy Asthma Rep 2023; 23:531-540. [PMID: 37405680 DOI: 10.1007/s11882-023-01099-6] [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] [Accepted: 06/05/2023] [Indexed: 07/06/2023]
Abstract
PURPOSE OF REVIEW Environmental home assessments have traditionally been performed in-person at the homes of Children's Mercy Kansas City patients. The COVID-19 pandemic brought many challenges to the way patients interact with their healthcare providers, including home visiting programs. Reaching out to patients with high-risk asthma and immunocompromised health was still needed, despite the pandemic. This project's purpose was to develop a virtual (telemedicine) healthy home assessment protocol that would continue to meet patients' needs during the isolation resulting from the pandemic. RECENT FINDINGS This is a newly developing approach to performing home environmental assessments with limited published research. Research on the effective use of telemedicine as an alternative to in-person clinic visits has shown that for some health conditions telemedicine represents a useful technique to engage with patients and caregivers. For some conditions, like pediatric asthma, it provides a similar level of efficacy in disease management while providing a more efficient form of interaction. This article describes the development and delivery process, timelines of caregiver interaction, and guidelines for performing virtual home assessments. It summarizes the challenges and benefits of using a virtual process for delivering home assessment services for asthma and allergy patients. Overall, caregivers indicated they found the use of virtual technology had significant benefits for them including their personal comfort and the time efficiency gained by using virtual visits to interact with Healthy Homes Program staff.
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Affiliation(s)
- Ryan Allenbrand
- Environmental Health Program, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108, USA.
| | - Anita DiDonna
- Environmental Health Program, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108, USA
| | - Jenny Marshall
- Department of Strategy, Innovation, and Partnerships, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108, USA
| | - Kevin Kennedy
- Environmental Health Program, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108, USA
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Robbins E, Johal K, Keswani A. The Use and Teaching of Telemedicine in Allergy/Immunology Training Programs. Curr Allergy Asthma Rep 2023; 23:463-470. [PMID: 37418070 DOI: 10.1007/s11882-023-01096-9] [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] [Accepted: 05/17/2023] [Indexed: 07/08/2023]
Abstract
PURPOSE OF REVIEW The use of telemedicine has greatly increased since the onset of the coronavirus disease 2019 (COVID-19) pandemic. This review discusses the types of telemedicine, current telehealth curricula in medical education, and benefits and disadvantages of incorporation of telemedicine into Allergy/Immunology training programs. RECENT FINDINGS The majority of Allergists/Immunologists use telemedicine in their clinical practice with leaders in graduate medical education recommending inclusion of telemedicine in training. Fellows-in-training reported that use of telemedicine in Allergy/Immunology training during the pandemic mitigated some concerns for lack of adequate clinical experience. Still, no standardized curriculum for telemedicine training in Allergy/Immunology exists, although curricula from internal medicine and primary care residencies can provide a framework for incorporation of telemedicine training into fellowship. Benefits of telemedicine in Allergy/Immunology training include enhanced immunology training, home environment monitoring, and flexibility to reduce physician burnout while disadvantages include limited physical examination skill building and lack of a standardized curriculum. As telemedicine has been widely accepted in medicine with high patient satisfaction, it is necessary to incorporate a standardized telehealth curriculum in Allergy/Immunology fellowship training, both as a tool for patient care as well as trainee education.
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Affiliation(s)
- Emily Robbins
- National Institute of Allergy and Immunology, National Institute of Health, Bethesda, MD, USA
| | - Kirti Johal
- Division of Allergy/Immunology, George Washington University School of Medicine and Health Sciences, 2300 M St NW, Suite 200, Washington, DC, 20037, USA
| | - Anjeni Keswani
- Division of Allergy/Immunology, George Washington University School of Medicine and Health Sciences, 2300 M St NW, Suite 200, Washington, DC, 20037, USA.
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Pandya A, Parashar S, Waller M, Portnoy J. Telemedicine beyond the pandemic: challenges in the pediatric immunology clinic. Expert Rev Clin Immunol 2023; 19:1063-1073. [PMID: 37354030 DOI: 10.1080/1744666x.2023.2229956] [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: 02/19/2023] [Accepted: 06/22/2023] [Indexed: 06/25/2023]
Abstract
INTRODUCTION Telemedicine and electronic medical records (EMRs) have revolutionized healthcare in recent years, offering numerous benefits that improve the delivery of care and the overall patient outcomes. AREAS COVERED Telemedicine allows providers to diagnose and treat patients remotely, often eliminating the need for face-to-face visits. Its benefits include improved access to care, convenience for patients, and reduced costs both for patients and providers. When used with remote patient monitoring and remote therapeutic monitoring, continuous care becomes possible. EMRs allow providers to store, access, and share patient information more efficiently than paper charts. The benefits of EMRs include improved patient safety, increased efficiency, and reduced costs. EXPERT OPINION The combination of telemedicine with EMRs makes it possible to envision the advent of computer-assisted diagnosis (CAD). This technology uses artificial intelligence and machine learning algorithms to analyze medical information including images, clinical and physiologic data, test results and remotely obtained information to support healthcare providers in making accurate diagnoses. By providing providers with what is essentially a second opinion, CAD systems can help prevent misdiagnoses and improve the quality of care. Such systems are not meant to replace healthcare providers, but rather to support them in making more informed and accurate diagnoses.
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Affiliation(s)
- Aarti Pandya
- Section of Allergy/Immunology, Children's Mercy Hospital, Kansas City, MO, United States
| | - Sonya Parashar
- Section of Allergy/Immunology, Children's Mercy Hospital, Kansas City, MO, United States
| | - Morgan Waller
- Section of Allergy/Immunology, Children's Mercy Hospital, Kansas City, MO, United States
| | - Jay Portnoy
- Section of Allergy/Immunology, Children's Mercy Hospital, Kansas City, MO, United States
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Expanding Quality by Design Principles to Support 3D Printed Medical Device Development Following the Renewed Regulatory Framework in Europe. Biomedicines 2022; 10:biomedicines10112947. [PMID: 36428514 PMCID: PMC9687721 DOI: 10.3390/biomedicines10112947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/09/2022] [Accepted: 11/11/2022] [Indexed: 11/18/2022] Open
Abstract
The vast scope of 3D printing has ignited the production of tailored medical device (MD) development and catalyzed a paradigm shift in the health-care industry, particularly following the COVID pandemic. This review aims to provide an update on the current progress and emerging opportunities for additive manufacturing following the introduction of the new medical device regulation (MDR) within the EU. The advent of early-phase implementation of the Quality by Design (QbD) quality management framework in MD development is a focal point. The application of a regulatory supported QbD concept will ensure successful MD development, as well as pointing out the current challenges of 3D bioprinting. Utilizing a QbD scientific and risk-management approach ensures the acceleration of MD development in a more targeted way by building in all stakeholders' expectations, namely those of the patients, the biomedical industry, and regulatory bodies.
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11
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Abdullah B, Snidvongs K, Poerbonegoro NL, Sutikno B. Reshaping the Management of Allergic Rhinitis in Primary Care: Lessons from the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192013632. [PMID: 36294211 PMCID: PMC9603682 DOI: 10.3390/ijerph192013632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/15/2022] [Accepted: 10/16/2022] [Indexed: 05/04/2023]
Abstract
The COVID-19 pandemic presented unique challenges to the delivery of healthcare for patients with allergic rhinitis (AR) following its disruption and impact on the healthcare system with profound implications. Reliance on self-care for AR symptom management was substantial during the pandemic with many patients encouraged to only seek in-person medical care when necessary. The advantage of digital technology becomes apparent when patients and healthcare providers had to change and adapt their method of interaction from the regular physical face-to-face consultation to telehealth and mobile health in the provision of care. Despite the pandemic and the ever-evolving post pandemic situation, optimal management of AR remains paramount for both patients and healthcare professionals. A reshaping of the delivery of care is essential to accomplish this goal. In this paper, we present what we have learned about AR management during the COVID-19 pandemic, the role of digital technology in revolutionizing AR healthcare, screening assessment in the identification and differentiation of common upper respiratory conditions, and a framework to facilitate the management of AR in primary care.
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Affiliation(s)
- Baharudin Abdullah
- Department of Otorhinolaryngology—Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
- Correspondence: or
| | - Kornkiat Snidvongs
- Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | | | - Budi Sutikno
- Faculty of Medicine, Universitas Airlangga, Jl. Mayjen. Prof. Dr. Moestopo No. 6-8, Surabaya 60286, Indonesia
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The Future of Telehealth for Allergic Disease. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY: IN PRACTICE 2022; 10:2514-2523. [PMID: 36038132 PMCID: PMC9420069 DOI: 10.1016/j.jaip.2022.08.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 08/01/2022] [Accepted: 08/22/2022] [Indexed: 11/24/2022]
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13
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Gilkey MB, Kong WY, Kennedy KL, Heisler-MacKinnon J, Faugno E, Gwinn B, Wu AC, Loughlin CE, Galbraith AA. Leveraging Telemedicine to Reduce the Financial Burden of Asthma Care. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:2536-2542. [PMID: 35644331 DOI: 10.1016/j.jaip.2022.05.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/04/2022] [Accepted: 05/17/2022] [Indexed: 06/15/2023]
Abstract
One of the most compelling arguments for telemedicine is its potential to increase health care access by making care more affordable for patients and families, including those affected by asthma. This goal is critically important in the United States, where the high cost of asthma care is associated with nonadherence to preventive care regimens and suboptimal health outcomes. In this clinical commentary review, we draw from the literature and our own research to identify opportunities for and challenges to leveraging telemedicine to reduce the financial burden of asthma care. Our interviews with 42 families affected by asthma during the COVID-19 pandemic suggest that under favorable circumstances, telemedicine can meaningfully reduce costs, including those related to transportation and missed work, while offering high-quality care. However, families also identified ways in which telemedicine can increase costs. For example, some reported reduced access to support services and material resources such as medication samples, which they relied on to manage costs. In this way, our findings underscore the need for careful care coordination and communication in telemedicine. We conclude by discussing the 4Rs, a structured communication approach designed to support cost conversations, increase care coordination, and help families reduce asthma care cost burden.
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Affiliation(s)
- Melissa B Gilkey
- Department of Health Behavior, University of North Carolina, Chapel Hill, NC.
| | - Wei Yi Kong
- Department of Health Behavior, University of North Carolina, Chapel Hill, NC
| | - Kathryn L Kennedy
- Department of Health Behavior, University of North Carolina, Chapel Hill, NC
| | | | - Elena Faugno
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Mass
| | - Barbara Gwinn
- NC Children's Allergy and Asthma Center, UNC Health, Chapel Hill, NC
| | - Ann Chen Wu
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Mass
| | - Ceila E Loughlin
- NC Children's Allergy and Asthma Center, UNC Health, Chapel Hill, NC; Department of Pediatrics, Division of Pulmonology, University of North Carolina, Chapel Hill, NC
| | - Alison A Galbraith
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Mass
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14
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Patient and Clinician Attitudes Toward Telemedicine for Allergy and Immunology. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY: IN PRACTICE 2022; 10:2493-2499. [PMID: 35618214 PMCID: PMC9124630 DOI: 10.1016/j.jaip.2022.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/09/2022] [Accepted: 05/11/2022] [Indexed: 01/02/2023]
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15
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Bukstein DA, Eghrari-Sabet J, Hart M, Hill T, Parikh P, Winders TA. COVID-19 pandemic impact on telehealth use and perceptions for atopic and respiratory disease: Survey results. Allergy Asthma Proc 2022; 43:194-201. [PMID: 35524354 DOI: 10.2500/aap.2022.43.220019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background: Telehealth use increased during the coronavirus disease 2019 (COVID-19) pandemic to provide patient care while deferring to social distancing recommendations. Objective: Health-care provider and patient surveys were conducted to assess the impact of COVID-19 on the use and perception of telehealth visits for atopic and respiratory diseases. Methods: Health-care provider (N = 200) and patient (N = 200) surveys were conducted in the United States between September and October, 2020, and January, 2021. The participants were required to have used telehealth before or after March 1, 2020, the cutoff date selected to represent the start of the COVID-19 pandemic. Results: Before the pandemic, 40% of the health-care provider participants were conducting telehealth visits, which increased to 100% after the pandemic started. The average time spent per telehealth visit with patients increased from 13 to 16 minutes. A higher percentage of family medicine physicians/pediatricians had access to most monitoring tools than allergy/dermatology specialists both before the pandemic and after the pandemic started. Practice expenses reportedly increased after the pandemic started for 42% of participants. Before the pandemic, 27% of the patient participants used telehealth, which increased to 94% after the pandemic started. Ratings of "good" or "excellent" for the overall telehealth experience by the health-care provider participants improved from 44% before to 60% after the pandemic started, and by the patient participants improved from 77% to 88%. The willingness by the health-care provider participants to recommend telehealth to colleagues improved from 73% before to 83% after the pandemic started. The willingness by the patient participants to use telehealth again dropped slightly, from 94% to 89%. Conclusion: Telehealth visits for atopic and respiratory diseases increased during the COVID-19 pandemic. Telehealth experiences were overall positive, particularly for the patients.
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Affiliation(s)
- Don A. Bukstein
- From the Allergy, Asthma and Sinus Center, Milwaukee, Wisconsin
| | | | - Mary Hart
- Allergy and Asthma Network, Vienna, Virginia
| | - Tanisha Hill
- Teva Pharmaceuticals, Parsippany, New Jersey; and
| | - Purvi Parikh
- Division of Infectious Disease and Immunology, Departments of Medicine and Pediatrics, New York University School of Medicine, New York University Langone Health, New York, New York
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16
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Barbosa MT, Sousa CS, Morais-Almeida M. Telemedicine in the Management of Chronic Obstructive Respiratory Diseases: An Overview. Digit Health 2022. [DOI: 10.36255/exon-publications-digital-health-respiratory-diseases] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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17
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Critical Retrospection of Performance of Emerging Mobile Technologies in Health Data Management. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:8903604. [PMID: 35345655 PMCID: PMC8957038 DOI: 10.1155/2022/8903604] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/16/2022] [Accepted: 02/16/2022] [Indexed: 11/25/2022]
Abstract
The recent advancement in mobile technologies has led to opening a new paradigm in the field of medical healthcare systems. The development of WBAN sensors, wearable devices, and 5G/6G wireless technology has made real-time monitoring and telecare of the patient feasible. The complex framework to secure sensitive data of the patient and healthcare professionals is critical. The fast computation of health data generated is crucial for disease prediction and trauma-related services; the security of data and financial transactions is also a major concern. Various models, algorithms, and frameworks have been developed to tame critical issues related to healthcare services. The efficiency of these frameworks and models depends on energy and time consumption. Thus, the review of recent emerging technologies in respect of energy and time consumption is required. This paper reviews the developments in recent mobile technologies, their application, and the comparative analysis of their performance parameters to explicitly understand the utility, capacity, and limitations. This will help to understand the shortcomings of the recent technologies for the development of better frameworks with higher performance capabilities as well as higher quality of services.
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18
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Lang DM. THE IMPACT OF TELEMEDICINE AS A DISRUPTIVE INNOVATION ON ALLERGY/IMMUNOLOGY PRACTICE. Ann Allergy Asthma Immunol 2021; 128:146-151. [PMID: 34775080 DOI: 10.1016/j.anai.2021.11.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/21/2021] [Accepted: 11/01/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Urban minority preschool children are disproportionately affected by asthma with increased asthma morbidity and mortality. It is important to understand how families manage asthma in preschool children in order to improve asthma control. OBJECTIVE This study examines family asthma management and asthma outcomes among a low-income urban minority population of Head Start preschool children. METHODS The Family Asthma Management System Scale (FAMSS) assesses how families manage a child's asthma. 388 caregivers completed the FAMSS at baseline. Asthma outcomes were assessed at baseline and prospectively at 6 months, including asthma control (based on the Test for Respiratory and Asthma Control in Kids), courses of oral corticosteroids required, and caregiver health-related quality of life (Pediatric Asthma Caregiver's Quality of Life Questionnaire (PACQLQ)). Multiple regression models assessed the relationship between the FAMSS Total Score, FAMSS subscales, and asthma outcomes. RESULTS Higher FAMSS Total scores were associated with fewer courses of oral corticosteroids required (b=-0.23, p<0.01) and higher PACQLQ scores (b=0.07, p<0.05). At baseline, higher Integration subscale scores (b=-0.19, p<0.05) were associated with fewer courses of oral corticosteroids required, and higher Family Response scores were associate with higher PACQLQ scores (b=0.06, p<0.05). However, higher Collaboration scores were associated with lower PACQLQ at baseline (b=-0.06, p<0.05) and 6 months (b=-0.07, p<0.05). CONCLUSION Among this population of low-income minority preschool children, understanding how a family manages their child's asthma may help identify gaps for education to possibly improve caregiver asthma-related quality of life and reduce courses of oral corticosteroids.
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Affiliation(s)
- David M Lang
- Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic.
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19
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Alvarez-Perea A, Dimov V, Popescu FD, Zubeldia JM. The applications of eHealth technologies in the management of asthma and allergic diseases. Clin Transl Allergy 2021; 11:e12061. [PMID: 34504682 PMCID: PMC8420996 DOI: 10.1002/clt2.12061] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 08/20/2021] [Accepted: 08/25/2021] [Indexed: 01/14/2023] Open
Abstract
Portable devices, such as smartphones and mobile Internet access have become ubiquitous in the last decades. The term 'eHealth' stands for electronic health. The tools included in the eHealth concept utilize phones, computers and the Internet and related applications to improve the health care industry. Implementation of eHealth technologies has been documented for the management of different chronic diseases, including asthma and allergic conditions. Clinicians and patients have gained opportunity to communicate in new ways, which could be used cost-effectively to improve disease control and quality of life of those affected. Additionally, these innovations bring new opportunities to academic researchers. For example, eHealth has allowed researchers to compile data points that were previously unavailable or difficult to access, and analyse them using novel tools, collectively described as 'big data'. The role of eHealth become more important since early 2020, due to the physical distancing rules and the restrictions on mobility that have been applied worldwide as a response to the coronavirus disease 2019 pandemic. In this review, we summarize the most recent developments in various eHealth platforms and their relevance to the speciality of allergy and immunology, from the point of view of three major stakeholders: clinicians, patients and researchers.
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Affiliation(s)
- Alberto Alvarez-Perea
- Allergy Service Hospital General Universitario Gregorio Marañón Madrid Spain.,Gregorio Marañón Health Research Institute Madrid Spain
| | - Ves Dimov
- Cleveland Clinic Florida FAU Charles E. Schmidt College of Medicine Weston Florida USA
| | - Florin-Dan Popescu
- Department of Allergology 'Nicolae Malaxa' Clinical Hospital 'Carol Davila' University of Medicine and Pharmacy Bucharest Romania
| | - José Manuel Zubeldia
- Allergy Service Hospital General Universitario Gregorio Marañón Madrid Spain.,Gregorio Marañón Health Research Institute Madrid Spain.,Biomedical Research Network on Rare Diseases (CIBERER)-U761 Madrid Spain
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20
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Tang Z, Hu H, Xu C, Zhao K. Exploring an Efficient Remote Biomedical Signal Monitoring Framework for Personal Health in the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9037. [PMID: 34501625 PMCID: PMC8430740 DOI: 10.3390/ijerph18179037] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 08/06/2021] [Accepted: 08/26/2021] [Indexed: 12/22/2022]
Abstract
Nowadays people are mostly focused on their work while ignoring their health which in turn is creating a drastic effect on their health in the long run. Remote health monitoring through telemedicine can help people discover potential health threats in time. In the COVID-19 pandemic, remote health monitoring can help obtain and analyze biomedical signals including human body temperature without direct body contact. This technique is of great significance to achieve safe and efficient health monitoring in the COVID-19 pandemic. Existing remote biomedical signal monitoring methods cannot effectively analyze the time series data. This paper designs a remote biomedical signal monitoring framework combining the Internet of Things (IoT), 5G communication and artificial intelligence techniques. In the constructed framework, IoT devices are used to collect biomedical signals at the perception layer. Subsequently, the biomedical signals are transmitted through the 5G network to the cloud server where the GRU-AE deep learning model is deployed. It is noteworthy that the proposed GRU-AE model can analyze multi-dimensional biomedical signals in time series. Finally, this paper conducts a 24-week monitoring experiment for 2000 subjects of different ages to obtain real data. Compared with the traditional biomedical signal monitoring method based on the AutoEncoder model, the GRU-AE model has better performance. The research has an important role in promoting the development of biomedical signal monitoring techniques, which can be effectively applied to some kinds of remote health monitoring scenario.
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Affiliation(s)
- Zhongyun Tang
- School of Computer Science and Technology, Hangzhou Dianzi University, Hangzhou 310014, China; (Z.T.); (H.H.)
- School of Information and Electronic Engineering, Zhejiang Gongshang University, Hangzhou 310018, China
| | - Haiyang Hu
- School of Computer Science and Technology, Hangzhou Dianzi University, Hangzhou 310014, China; (Z.T.); (H.H.)
| | - Chonghuan Xu
- School of Business Administration, Zhejiang Gongshang University, Hangzhou 310018, China
- Modern Business Research Center, Zhejiang Gongshang University, Hangzhou 310018, China
- Zheshang Research Institute, Zhejiang Gongshang University, Hangzhou 310018, China
| | - Kaidi Zhao
- School of Information Science and Technology, Fudan University, Shanghai 200433, China;
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21
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Vilendrer S, Sackeyfio S, Akinbami E, Ghosh R, Luu JH, Pathak D, Shimada M, Williamson EE, Shieh L. Patient Perspectives of Inpatient Telemedicine During COVID-19: A Qualitative Assessment (Preprint). JMIR Form Res 2021; 6:e32933. [PMID: 35147510 PMCID: PMC8970158 DOI: 10.2196/32933] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 01/26/2022] [Accepted: 01/27/2022] [Indexed: 01/23/2023] Open
Abstract
Background Telemedicine has been adopted in the inpatient setting to facilitate clinical interactions between on-site clinicians and isolated hospitalized patients. Such remote interactions have the potential to reduce pathogen exposure and use of personal protective equipment but may also pose new safety concerns given prior evidence that isolated patients can receive suboptimal care. Formal evaluations of the use and practical acceptance of inpatient telemedicine among hospitalized patients are lacking. Objective We aimed to evaluate the experience of patients hospitalized for COVID-19 with inpatient telemedicine introduced as an infection control measure during the pandemic. Methods We conducted a qualitative evaluation in a COVID-19 designated non–intensive care hospital unit at a large academic health center (Stanford Health Care) from October 2020 through January 2021. Semistructured qualitative interviews focused on patient experience, impact on quality of care, communication, and mental health. Purposive sampling was used to recruit participants representing diversity across varying demographics until thematic saturation was reached. Interview transcripts were qualitatively analyzed using an inductive-deductive approach. Results Interviews with 20 hospitalized patients suggested that nonemergency clinical care and bridging to in-person care comprised the majority of inpatient telemedicine use. Nurses were reported to enter the room and call on the tablet far more frequently than physicians, who typically entered the room at least daily. Patients reported broad acceptance of the technology, citing improved convenience and reduced anxiety, but preferred in-person care where possible. Quality of care was believed to be similar to in-person care with the exception of a few patients who wanted more frequent in-person examinations. Ongoing challenges included low audio volume, shifting tablet location, and inconsistent verbal introductions from the clinical team. Conclusions Patient experiences with inpatient telemedicine were largely favorable. Although most patients expressed a preference for in-person care, telemedicine was acceptable given the circumstances associated with the COVID-19 pandemic. Improvements in technical and care team use may enhance acceptability. Further evaluation is needed to understand the impact of inpatient telemedicine and the optimal balance between in-person and virtual care in the hospital setting.
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Affiliation(s)
- Stacie Vilendrer
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, United States
| | - Sarah Sackeyfio
- Department of Physics, Stanford University, Stanford, CA, United States
| | - Eliel Akinbami
- Department of Bioengineering, Stanford University, Stanford, CA, United States
| | - Roy Ghosh
- Department of Bioengineering, Stanford University, Stanford, CA, United States
| | - Jacklyn Ha Luu
- Department of Bioinformatics, Stanford University School of Medicine, Stanford, CA, United States
| | - Divya Pathak
- Department of Biochemistry, Stanford University, Stanford, CA, United States
| | - Masahiro Shimada
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, United States
| | | | - Lisa Shieh
- Division of Hospital Medicine, Stanford University School of Medicine, Stanford, CA, United States
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22
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Abstract
BACKGROUND Heart failure (HF) is a multifaceted syndrome that requires self-management for adherence to treatment to control symptoms. Symptoms need to be monitored to prevent impending HF exacerbations. Few HF study authors have assessed efficacy of mobile health (mHealth) interventions particularly with virtual visits to evaluate outcomes such as symptoms and healthcare utilization. OBJECTIVE The aim of this pilot study was to evaluate the potential effect of mHealth self-management interventions on symptom status and health-related quality of life and describe health care utilization in patients with HF. METHODS This 3-month pilot study included 74 patients with HF and used a randomized 3-group repeated-measures design (enhanced usual care, mHealth, and mHealth plus [+] virtual visits). Surveys included the Heart Failure Symptom Survey, EuroQol, and a specialized phone application for patients to report weights and medications. RESULTS The mHealth groups had an overall decrease in most symptom severity and frequency, particularly shortness of breath. Compared to enhanced usual care, both the mHealth+ and mHealth groups showed promise with medium effect sizes (range .55-.60) in relation to shortness of breath and a medium effect (.51) for lower extremity edema for the mHealth+ group. There was a trend toward improvement in health-related quality of life in both intervention groups at month 3. The mHealth+ group had fewer rehospitalizations. CONCLUSIONS In general, both mHealth groups fared better on symptoms and health care utilization. Small to medium effect sizes on selected symptom outcomes warrant this study to be conducted in a fully powered study. Virtual visits may assist in symptom recognition and self-management.
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23
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Kavya R, Christopher J, Panda S, Lazarus YB. Machine Learning and XAI approaches for Allergy Diagnosis. Biomed Signal Process Control 2021. [DOI: 10.1016/j.bspc.2021.102681] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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24
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Dramburg S, Walter U, Becker S, Casper I, Röseler S, Schareina A, Wrede H, Klimek L. Praktischer Leitfaden zum Einsatz telemedizinischer Anwendungen bei der Betreuung von Allergiepatienten. ALLERGO JOURNAL 2021; 30:24-38. [PMID: 34149193 PMCID: PMC8200790 DOI: 10.1007/s15007-021-4823-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Seit Frühjahr 2020 führten die weitreichenden Maßnahmen zur Kontaktbeschränkung im Rahmen der SARS-CoV-2-Pandemie auch zu einer Reduktion der Arzt-Patienten-Kontakte im ambulanten Versorgungsbereich. Telemedizinische Anwendungen werden zunehmend eine Möglichkeit darstellen, die Patientenversorgung unter Infektionsschutzmaßnahmen effizient zu gewährleisten. Auch in der Allergologie können telemedizinische wie digitale Anwendungen den klinischen Alltag deutlich erleichtern. Die mit der Implementierung digitaler Strategien verbundenen technischen und rechtlichen Hürden müssen hierfür jedoch generell überwunden werden.
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Affiliation(s)
- Stephanie Dramburg
- Klinik für Pädiatrie m. S. Pneumologie, Immunologie und Intensivmedizin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Uso Walter
- Praxis für Hals-, Nasen- und Ohrenheilkunde Walter und Sachse, Duisburg, Germany
| | - Sven Becker
- Universitätsklinik Tübingen, Elfriede-Aulhorn-Straße 5, 72076 Tübingen, Germany
| | - Ingrid Casper
- Zentrum für Rhinologie und Allergologie Wiesbaden, Wiesbaden, Germany
| | - Stefani Röseler
- Klinik für Dermatologie und Allergologie, Pauwelsstr. 30, 52074 Aachen, Germany
| | - Astrid Schareina
- Klinik für Pädiatrie m. S. Pneumologie, Immunologie und Intensivmedizin, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Praxis für Hals-, Nasen- und Ohrenheilkunde Walter und Sachse, Duisburg, Germany.,Universitätsklinik Tübingen, Elfriede-Aulhorn-Straße 5, 72076 Tübingen, Germany.,Zentrum für Rhinologie und Allergologie Wiesbaden, Wiesbaden, Germany.,Klinik für Dermatologie und Allergologie, Pauwelsstr. 30, 52074 Aachen, Germany.,Hals-, Nasen- und Ohrenarzt, Herford, Germany.,Zentrum f. Rhinologie und Allergologie, An den Quellen 10, 65183 Wiesbaden, Germany
| | | | - Ludger Klimek
- Zentrum f. Rhinologie und Allergologie, An den Quellen 10, 65183 Wiesbaden, Germany
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25
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Zhang C, Peng XQ, Jiang YZ, Liu R, Qi ZX, Zhou M, Zhao SQ, Ge JJ, You H, Li ZG. Online medical services utilization evaluated through the lens of socioecological theory and the information-motivation-behavioral skills model: evidence from China. Ann N Y Acad Sci 2021; 1500:82-92. [PMID: 33983658 DOI: 10.1111/nyas.14609] [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: 12/26/2020] [Revised: 04/13/2021] [Accepted: 04/21/2021] [Indexed: 12/01/2022]
Abstract
Online medical services (OMS) have become increasingly advantageous, but there are still several barriers to utilization among patients. This study aims to explore the factors influencing OMS utilization (OMSU) for patients in micro-, meso-, and macrosystems based on socioecological theory (SET) and from the perspective of the information-motivation-behavioral skills (IMB) model. We selected 1065 participants through multistage stratified cluster random sampling in Jiangsu, China. In microsystems, information and behavioral skills were positively associated with intention (β = 0.84; β = 3.21) and actual utilization (OR = 1.69; OR = 1.69). Education level (β = 0.83) and personal motivation (β = 1.68) were positively related to intention. Chronic diseases (OR = 2.03) had a positive relationship with actual use. In mesosystems, recommendations from people around the patients (β = 1.14; OR = 1.99), provision of OMS in the nearest primary medical facility (β = 0.98; OR = 3.60), and provision of instructional information by medical institutions (β = 1.01; OR = 1.65) were related to OMSU. The average monthly household income (β = 0.54) was related to intention. Patients who had information about the OMSU experiences of people around them (OR = 1.73) correlated with actual utilization. In macrosystems, the social medical insurance type (OR = 0.66) was associated with OMSU. This study supports the applicability of the SET and IMB model to interpret patients' OMSU.
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Affiliation(s)
- Chi Zhang
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Xue-Qing Peng
- School of Public Health, Nanjing Medical University, Nanjing, China
| | - Yong-Zhi Jiang
- School of Health Policy & Management, Nanjing Medical University, Nanjing, China
| | - Rui Liu
- School of Health Policy & Management, Nanjing Medical University, Nanjing, China
| | - Zi-Xin Qi
- School of Health Policy & Management, Nanjing Medical University, Nanjing, China
| | - Meng Zhou
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Shi-Qi Zhao
- School of Public Health, Nanjing Medical University, Nanjing, China
| | - Jin-Jin Ge
- School of Public Health, Nanjing Medical University, Nanjing, China
| | - Hua You
- School of Nursing, Nanjing Medical University, Nanjing, China.,School of Public Health, Nanjing Medical University, Nanjing, China
| | - Zhi-Guang Li
- School of Health Policy & Management, Nanjing Medical University, Nanjing, China.,The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
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26
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Rangachari P, Mushiana SS, Herbert K. A Narrative Review of Factors Historically Influencing Telehealth Use across Six Medical Specialties in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094995. [PMID: 34066829 PMCID: PMC8125887 DOI: 10.3390/ijerph18094995] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 04/30/2021] [Accepted: 05/04/2021] [Indexed: 12/13/2022]
Abstract
Prior to the COVID-19 pandemic, studies in the US have identified wide variations in telehealth use across medical specialties. This is an intriguing problem, because the US has historically lacked a standardized set of telehealth coverage and reimbursement policies, which has posed a barrier to telehealth use across all specialties. Although all medical specialties in the US have been affected by these macro (policy-level) barriers, some specialties have been able to integrate telehealth use into mainstream practice, while others are just gaining momentum with telehealth during COVID-19. Although the temporary removal of policy (coverage) restrictions during the pandemic has accelerated telehealth use, uncertainties remain regarding future telehealth sustainability. Since macro (policy-level) factors by themselves do not serve to explain the variation in telehealth use across specialties, it would be important to examine meso (organizational-level) and micro (individual-level) factors historically influencing telehealth use across specialties, to understand underlying reasons for variation and identify implications for widespread sustainability. This paper draws upon the existing literature to develop a conceptual framework on macro-meso-micro factors influencing telehealth use within a medical specialty. The framework is then used to guide a narrative review of the telehealth literature across six medical specialties, including three specialties with lower telehealth use (allergy-immunology, family medicine, gastroenterology) and three with higher telehealth use (psychiatry, cardiology, radiology) in the US, in order to synthesize themes and gain insights into barriers and facilitators to telehealth use. In doing so, this review addresses a gap in the literature and provides a foundation for future research. Importantly, it helps to identify implications for ensuring widespread sustainability of telehealth use in the post-pandemic future.
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Affiliation(s)
- Pavani Rangachari
- Department of Interdisciplinary Health Sciences Augusta University, Augusta, GA 30912, USA
- Department of Family Medicine, Augusta University, Augusta, GA 30912, USA
- Correspondence: ; Tel.: +1-706-721-2622
| | - Swapandeep S. Mushiana
- School of Nursing and Health Professions, University of San Francisco, San Francisco, CA 94117, USA;
| | - Krista Herbert
- Department of Clinical Psychology, Rowan University, Glassboro, NJ 08028, USA;
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27
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Linton S, Burrows AG, Hossenbaccus L, Ellis AK. Future of allergic rhinitis management. Ann Allergy Asthma Immunol 2021; 127:183-190. [PMID: 33971355 DOI: 10.1016/j.anai.2021.04.029] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 04/22/2021] [Accepted: 04/28/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To present a comprehensive, clinically focused scoping review of therapeutic agents and practices comprising the future of allergic rhinitis (AR) management. DATA SOURCES A review of the published literature was performed using the PubMed database, published abstracts, and virtual presentations from scientific meetings and posted results on ClinicalTrials.gov. STUDY SELECTIONS Primary manuscripts with trial results, case reports, case series, and clinical trial data from ClinicalTrials.gov, PubMed, and articles highlighting expert perspectives on management of AR were selected. RESULTS Telemedicine, social media, and mHealth facilitate integrated care for AR management. Pharmacotherapy remains the standard of care for AR management; however, treatment combinations are recommended. Intralymphatic immunotherapy and peptide immunotherapy are the most promising new allergen immunotherapy options. Studies of targeted biologics for AR are ongoing. Probiotics may be beneficial for AR management, particularly Bifidobacterium spp, and as an add-on to allergen immunotherapy. CONCLUSION AR is a chronic and often comorbid condition that requires integrated care for optimal management. New formulations and combinations of existing AR therapies are the most promising and merit future research.
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Affiliation(s)
- Sophia Linton
- Allergy Research Unit, Kingston Health Sciences Center-Kingston General Hospital Site, Kingston, Ontario, Canada; Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Alyssa G Burrows
- Allergy Research Unit, Kingston Health Sciences Center-Kingston General Hospital Site, Kingston, Ontario, Canada
| | - Lubnaa Hossenbaccus
- Allergy Research Unit, Kingston Health Sciences Center-Kingston General Hospital Site, Kingston, Ontario, Canada; Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
| | - Anne K Ellis
- Allergy Research Unit, Kingston Health Sciences Center-Kingston General Hospital Site, Kingston, Ontario, Canada; Department of Medicine, Queen's University, Kingston, Ontario, Canada; Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada.
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Tsao LR, Villanueva SA, Pines DA, Pham MN, Choo EM, Tang MC, Otani IM. Impact of Rapid Transition to Telemedicine-Based Delivery on Allergy/Immunology Care During COVID-19. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:2672-2679.e2. [PMID: 33894393 PMCID: PMC8061180 DOI: 10.1016/j.jaip.2021.04.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/26/2021] [Accepted: 04/07/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) necessitated wide-scale adoption of telemedicine (TM) and restriction of in-person care. The impacts on allergy/immunology (A/I) care delivery are still being studied. OBJECTIVE To describe the outcomes of rapid transition to TM-based care (video visit followed by in-person visits dedicated to diagnostic and therapeutic procedures when needed) at an academic A/I practice during COVID-19. METHODS Demographic data were compared for patients originally scheduled for in-person visits between March 10, 2020, and April 30, 2020, who completed a video visit instead between March 10, 2020, and June 30, 2020, and those who did not. Appointment completion, diagnoses, and drug allergy and skin testing completion were compared for visits between March 10, 2020, and June 30, 2020, and 1 year prior (March 10, 2019-June 30, 2019). RESULTS Sixty-nine percent (265 of 382) of patients originally scheduled between March 10, 2020, and April 30, 2020, were able to complete video visits. Patients who completed video visits were more likely to be white (52% vs 33%; P < .001), English-speaking (96% vs 89%; P = .01), and privately insured (70% vs 54%; P = .004). With TM-based care compared with in-person care, there were significant decreases in environmental and food skin testing completion rates (91% and 92% in 2019 vs 60% and 64% in 2020, respectively, P < .001). Drug allergy testing completed after internal referral remained low but comparable (51% in 2019 vs 52% in 2020). Transitioning nonprocedural visits to video allowed allergen immunotherapy and biologic injection visits to resume at a volume similar to pre-COVID. No COVID-19 infections resulted from in-clinic exposure. CONCLUSIONS Although transitioning to TM-based care allowed continued A/I care delivery, strategies are needed to achieve higher testing completion rates and ensure video visits do not exacerbate existing health disparities.
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Affiliation(s)
- Lulu R Tsao
- UCSF Department of Medicine, Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, San Francisco, Calif.
| | | | - David A Pines
- UCSF Adult Allergy/Immunology Clinic, San Francisco, Calif
| | - Michele N Pham
- UCSF Department of Medicine, Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, San Francisco, Calif
| | - Eugene M Choo
- UCSF Department of Medicine, Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, San Francisco, Calif
| | - Monica C Tang
- UCSF Department of Medicine, Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, San Francisco, Calif
| | - Iris M Otani
- UCSF Department of Medicine, Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, San Francisco, Calif
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29
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Mosnaim G, Safioti G, Brown R, DePietro M, Szefler SJ, Lang DM, Portnoy JM, Bukstein DA, Bacharier LB, Merchant RK. Digital Health Technology in Asthma: A Comprehensive Scoping Review. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:2377-2398. [PMID: 33652136 DOI: 10.1016/j.jaip.2021.02.028] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 02/04/2021] [Accepted: 02/04/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND A variety of digital intervention approaches have been investigated for asthma therapy during the past decade, with different levels of interactivity and personalization and a range of impacts on different outcome measurements. OBJECTIVE To assess the effectiveness of digital interventions in asthma with regard to acceptability and outcomes and evaluate the potential of digital initiatives for monitoring or treating patients with asthma. METHODS We evaluated digital interventions using a scoping review methodology through a literature search and review. Of 871 articles identified, 121 were evaluated to explore intervention characteristics, the perception and acceptability of digital interventions to patients and physicians, and effects on asthma outcomes. Interventions were categorized by their level of interactivity with the patient. RESULTS Interventions featuring non-individualized content sent to patients appeared capable of promoting improved adherence to inhaled corticosteroids, but with no identified improvement in asthma burden; and data-gathering interventions appeared to have little effect on adherence or asthma burden. Evidence of improvement in both adherence and patients' impairment due to asthma were seen only with interactive interventions involving two-way responsive patient communication. Digital interventions were generally positively perceived by patients and physicians. Implementation was considered feasible, with certain preferences for design and features important to drive use. CONCLUSIONS Digital health interventions show substantial promise for asthma disease monitoring and personalization of treatment. To be successful, future interventions will need to include both inhaler device and software elements, combining accurate measurement of clinical parameters with careful consideration of ease of use, personalization, and patient engagement aspects.
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Affiliation(s)
- Giselle Mosnaim
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, North Shore University Health System, Evanston, Ill
| | | | - Randall Brown
- Teva Branded Pharmaceutical Products R&D, Inc, West Chester, Pa
| | - Michael DePietro
- Teva Branded Pharmaceutical Products R&D, Inc, West Chester, Pa.
| | - Stanley J Szefler
- The Breathing Institute and Pulmonary Medicine Section, Children's Hospital Colorado and University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colo
| | - David M Lang
- Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jay M Portnoy
- Pediatric Allergy and Immunology, Children's Mercy Hospital, Kansas City School of Medicine, Kansas City, Mo
| | - Don A Bukstein
- Allergy, Asthma and Sinus Center, Milwaukee, Greenfield, Wis
| | - Leonard B Bacharier
- Department of Pediatrics, Monroe Carell Jr Children's Hospital at Vanderbilt University Medical Center, Nashville, Tenn
| | - Rajan K Merchant
- Woodland Clinic Medical Group, Allergy Department, Dignity Health, Woodland, Calif
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30
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Telemedicine in School for Asthma Education. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 8:1919-1920. [PMID: 32499037 DOI: 10.1016/j.jaip.2020.02.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 02/28/2020] [Indexed: 11/27/2022]
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Telemedicine in allergology: practical aspects: A position paper of the Association of German Allergists (AeDA). ACTA ACUST UNITED AC 2021; 30:119-129. [PMID: 33758744 PMCID: PMC7977487 DOI: 10.1007/s40629-021-00167-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 01/14/2021] [Indexed: 01/13/2023]
Abstract
Since spring 2020, the wide-ranging contact restriction measures in the context of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic have also led to a reduction in physician–patient contacts in the ambulatory care setting. Telemedicine applications will increasingly provide a way to efficiently deliver patient care under infection control measures. In allergology, telemedical as well as digital applications can also significantly facilitate everyday clinical practice. However, the technical and legal hurdles associated with the implementation of digital strategies must be overcome for this to happen. The aim of this article is to provide an intuitive overview of the aspects to be considered in the implementation of telemedicine consultations and to highlight the current state of the framework as well as optimization possibilities and perspectives in allergology. If a structured use is guaranteed, digital and telemedical applications can improve patient care—also in allergology. There is potential to be exploited in many areas, from the remote collection of clinical history, and video consultations, to the discussion of diagnostic findings, disease monitoring, and therapy support. The use of telemedical applications, especially video consultations, has experienced a remarkable acceleration in the context of the coronavirus disease 2019 (COVID-19) pandemic. The present overview of the legal, technical and professional framework is intended to support the anchoring of digital and telemedical technologies in everyday allergology. However, in order to consolidate these in the future, an agreement is needed regarding professional standards of action as well as a remuneration structure that is permanently defined beyond the current pandemic.
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Abstract
PURPOSE OF REVIEW Telemedicine, defined as synchronous video visits between a provider and a child with asthma, often takes place in the school setting. This review examines the new electronic sensors for adherence monitoring and studies that used telemedicine in the school setting to improve asthma outcomes. RECENT FINDINGS School-based telemedicine provides an important service to families of school-aged children who have difficulty due to time and distance in planning and keeping in-person appointments with primary or specialty providers. Significant improvements in objective measures of asthma control are inconsistently observed although caregiver and parent quality of life and child self-management behaviors are improved and satisfaction is high. Assessment and outcomes related to adherence are mentioned in studies but results are not often reported. However, it appears that adherence interventions are beneficial while maintained but the effects are not sustained upon intervention discontinuation. SUMMARY The school setting provides a convenient and suitable environment to conduct telemedicine visits between school-aged children and their primary care or specialty provider. Electronic adherence sensors allow review of controller and rescue medication use through a cloud-based dashboard and provides an opportunity for real-time assessment and intervention by providers to improve asthma outcomes.
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Affiliation(s)
- Kathryn V Blake
- Biomedical Research Department, Center for Pharmacogenomics and Translational Research, Nemours Children's Specialty Care, Jacksonville, Florida, USA
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33
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Thomas I, Siew LQC, Rutkowski K. Synchronous Telemedicine in Allergy: Lessons Learned and Transformation of Care During the COVID-19 Pandemic. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 9:170-176.e1. [PMID: 33091636 PMCID: PMC7571459 DOI: 10.1016/j.jaip.2020.10.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/16/2020] [Accepted: 10/01/2020] [Indexed: 01/28/2023]
Abstract
Background The outbreak of the COVID-19 pandemic facilitated a rapid transition to non–face-to-face models of care across the allergy services. Objective To describe the outcomes of the use of synchronous telemedicine for outpatient consultations in a tertiary adult allergy center. Methods We retrospectively reviewed all non–face-to-face appointments during the second month of the pandemic in the United Kingdom. Results A total of 637 non–face-to-face appointments for unique patients were booked between April 1 and 30, 2020; 91% were new consultations. Most referrals (81.5%) were related to nondrug reactions. The overall “Did Not Attend” rate was 15.7%. A total of 439 patients were assessed for nondrug reactions; 87% were new appointments. Food-related reactions (50.4%), urticaria/angioedema (23.2%), and rhinitis (18.1%) were the most common reasons for new referrals. Two hundred twenty-one (57.7%) of these patients required further allergy testing, primarily for suspected food allergy. More than 42% of the new patients, mainly referred for urticaria/angioedema, were discharged after their remote assessment. Less than 10% of the follow-up patients required additional testing. Ninety-seven new patients were assessed for a suspected drug reaction, predominantly to beta-lactam antibiotics (57.7%). Sixty-nine patients (71%) required further investigations, but a notable 29% did not require further allergy input. The overall experience was very good/good for most patients (85%). Conclusion Telemedicine can transform the current models of allergy care. Screening criteria for selecting suitable new patients are required. A telemedicine-based drug allergy service model can be more time- and cost-effective, and improve patient access to specialist care.
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Affiliation(s)
- Iason Thomas
- Department of Adult Allergy, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Peter Gorer Department of Immunobiology, King's College London, London, United Kingdom.
| | - Leonard Q C Siew
- Department of Adult Allergy, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Peter Gorer Department of Immunobiology, King's College London, London, United Kingdom
| | - Krzysztof Rutkowski
- Department of Adult Allergy, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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Lombardi JM, Bottiglieri T, Desai N, Riew KD, Boddapati V, Weller M, Bourgois C, McChrystal S, Lehman RA. Addressing a national crisis: the spine hospital and department's response to the COVID-19 pandemic in New York City. Spine J 2020; 20:1367-1378. [PMID: 32492529 PMCID: PMC7261362 DOI: 10.1016/j.spinee.2020.05.539] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 04/29/2020] [Accepted: 05/18/2020] [Indexed: 02/03/2023]
Abstract
In a very brief period, the COVID-19 pandemic has swept across the planet leaving governments, societies, and healthcare systems unprepared and under-resourced. New York City now represents the global viral epicenter with roughly one-third of all mortalities in the United States. To date, our hospital has treated thousands of COVID-19 positive patients and sits at the forefront of the United States response to this pandemic. The goal of this paper is to share the lessons learned by our spine division during a crisis when hospital resources and personnel are stretched thin. Such experiences include management of elective and emergent cases, outpatient clinics, physician redeployment, and general health and wellness. As peak infections spread across the United States, we hope this article will serve as a resource for other spine departments on how to manage patient care and healthcare worker deployment during the COVID-19 crisis.
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Affiliation(s)
- J M Lombardi
- The Och Spine Hospital, Department of Orthopaedic Surgery, Columbia University Medical Center, New York Presbyterian Hospital, 5141 Broadway at W 220th Street, New York, NY 10034.
| | - T Bottiglieri
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York Presbyterian Hospital, 622 W 168th Street, PH 11-Center, New York, NY 10032
| | - N Desai
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York Presbyterian Hospital, 622 W 168th Street, PH 11-Center, New York, NY 10032
| | - K D Riew
- The Och Spine Hospital, Department of Orthopaedic Surgery, Columbia University Medical Center, New York Presbyterian Hospital, 5141 Broadway at W 220th Street, New York, NY 10034
| | - V Boddapati
- The Och Spine Hospital, Department of Orthopaedic Surgery, Columbia University Medical Center, New York Presbyterian Hospital, 5141 Broadway at W 220th Street, New York, NY 10034
| | - M Weller
- Department of Anesthesiology, Columbia University Medical Center, New York Presbyterian Hospital, 622 W 168th Street, PH 11-Center, New York, NY 10032
| | - C Bourgois
- Department of Anesthesiology, Columbia University Medical Center, New York Presbyterian Hospital, 622 W 168th Street, PH 11-Center, New York, NY 10032
| | - S McChrystal
- The McChrystal Group, 333 N Fairfax Street, Alexandria, VA, 22314
| | - R A Lehman
- The Och Spine Hospital, Department of Orthopaedic Surgery, Columbia University Medical Center, New York Presbyterian Hospital, 5141 Broadway at W 220th Street, New York, NY 10034
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Morais-Almeida M, Sousa CS, Barbosa MT, Aguiar R, Benito-Garcia F. Telehealth: The future is now in allergy practice. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:2836-2837. [PMID: 32653648 PMCID: PMC7347352 DOI: 10.1016/j.jaip.2020.06.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/18/2020] [Accepted: 06/19/2020] [Indexed: 02/06/2023]
Affiliation(s)
| | | | | | - Rita Aguiar
- Allergy Centre, CUF Descobertas Hospital, Lisbon, Portugal
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36
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Miller MQ, Hadlock TA. Improving Outcomes Tracking in Facial Plastic and Reconstructive Surgery. Facial Plast Surg Aesthet Med 2020; 22:319-320. [PMID: 32498557 DOI: 10.1089/fpsam.2020.0230] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Affiliation(s)
- Matthew Q Miller
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Tessa A Hadlock
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
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37
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Greiwe J. Telemedicine in a Post-COVID World: How eConsults Can Be Used to Augment an Allergy Practice. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:2142-2143. [PMID: 32423575 PMCID: PMC7211663 DOI: 10.1016/j.jaip.2020.05.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 05/04/2020] [Accepted: 05/04/2020] [Indexed: 01/07/2023]
Affiliation(s)
- Justin Greiwe
- Bernstein Allergy Group, Inc., Cincinnati, Ohio; Division of Immunology/Allergy Section, Department of Internal Medicine, The University of Cincinnati College of Medicine, Cincinnati, Ohio.
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38
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Sun D, Heimall J. Geographical distribution of allergy/immunology providers in the United States and association with median income. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:2802-2804.e1. [PMID: 32334079 DOI: 10.1016/j.jaip.2020.04.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 03/30/2020] [Accepted: 04/07/2020] [Indexed: 01/17/2023]
Affiliation(s)
- Di Sun
- Department of Pediatrics, Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, Pa.
| | - Jennifer Heimall
- Department of Pediatrics, Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, Pa
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Abstract
The novel coronavirus pandemic, also known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has placed an immense strain on healthcare systems across the entire world. Consequently, multiple federal and state governments have placed restrictions on hospitals such as limiting "elective surgery" and recommending social or physical distancing. We review the literature on several areas that have been affected including surgical selection, inpatient care, and physician well-being. These areas affecting inpatient paradigms include surgical priority, physical or social distancing, file sharing for online clinical communications, and physician wellness. During this crisis, it is important that orthopaedic departments place an emphasis on personnel safety and slowing the spread of the virus so that the department can still maintain vital functions. Physical distancing and emerging technologies such as inpatient telemedicine and online file sharing applications can enable orthopaedic programs to still function while attempting to protect medical staff and patients from the novel coronavirus spread. This literature review sought to provide evidence-based guidance to orthopaedic departments during an unprecedented time. Orthopaedic surgeons should follow the Centers for Disease Control and Prevention guidelines, wear personal protective equipment (PPE) when appropriate, have teams created using physical distancing, understand the department's policy on elective surgery, and engage in routines which enhance physician wellness.
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40
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Clinician Wellness During the COVID-19 Pandemic: Extraordinary Times and Unusual Challenges for the Allergist/Immunologist. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:1781-1790.e3. [PMID: 32259628 PMCID: PMC7129776 DOI: 10.1016/j.jaip.2020.04.001] [Citation(s) in RCA: 108] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/01/2020] [Indexed: 12/12/2022]
Abstract
The global spread of coronavirus disease 2019 (COVID-19) has caused sudden and dramatic societal changes. The allergy/immunology community has quickly responded by mobilizing practice adjustments and embracing new paradigms of care to protect patients and staff from severe acute respiratory syndrome coronavirus 2 exposure. Social distancing is key to slowing contagion but adds to complexity of care and increases isolation and anxiety. Uncertainty exists across a new COVID-19 reality, and clinician well-being may be an underappreciated priority. Wellness incorporates mental, physical, and spiritual health to protect against burnout, which impairs both coping and caregiving abilities. Understanding the stressors that COVID-19 is placing on clinicians can assist in recognizing what is needed to return to a point of wellness. Clinicians can leverage easily accessible tools, including the Strength-Focused and Meaning-Oriented Approach to Resilience and Transformation approach, wellness apps, mindfulness, and gratitude. Realizing early warning signs of anxiety, depression, substance abuse, and posttraumatic stress disorder is important to access safe and confidential resources. Implementing wellness strategies can improve flexibility, resilience, and outlook. Historical parallels demonstrate that perseverance is as inevitable as pandemics and that we need not navigate this unprecedented time alone.
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Shaker MS, Oppenheimer J, Grayson M, Stukus D, Hartog N, Hsieh EWY, Rider N, Dutmer CM, Vander Leek TK, Kim H, Chan ES, Mack D, Ellis AK, Lang D, Lieberman J, Fleischer D, Golden DBK, Wallace D, Portnoy J, Mosnaim G, Greenhawt M. COVID-19: Pandemic Contingency Planning for the Allergy and Immunology Clinic. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:1477-1488.e5. [PMID: 32224232 PMCID: PMC7195089 DOI: 10.1016/j.jaip.2020.03.012] [Citation(s) in RCA: 210] [Impact Index Per Article: 52.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 03/18/2020] [Indexed: 01/15/2023]
Abstract
In the event of a global infectious pandemic, drastic measures may be needed that limit or require adjustment of ambulatory allergy services. However, no rationale for how to prioritize service shut down and patient care exists. A consensus-based ad-hoc expert panel of allergy/immunology specialists from the United States and Canada developed a service and patient prioritization schematic to temporarily triage allergy/immunology services. Recommendations and feedback were developed iteratively, using an adapted modified Delphi methodology to achieve consensus. During the ongoing pandemic while social distancing is being encouraged, most allergy/immunology care could be postponed/delayed or handled through virtual care. With the exception of many patients with primary immunodeficiency, patients on venom immunotherapy, and patients with asthma of a certain severity, there is limited need for face-to-face visits under such conditions. These suggestions are intended to help provide a logical approach to quickly adjust service to mitigate risk to both medical staff and patients. Importantly, individual community circumstances may be unique and require contextual consideration. The decision to enact any of these measures rests with the judgment of each clinician and individual health care system. Pandemics are unanticipated, and enforced social distancing/quarantining is highly unusual. This expert panel consensus document offers a prioritization rational to help guide decision making when such situations arise and an allergist/immunologist is forced to reduce services or makes the decision on his or her own to do so.
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Affiliation(s)
- Marcus S Shaker
- Dartmouth-Hitchcock Medical Center, Section of Allergy and Immunology, Lebanon, NH; Dartmouth Geisel School of Medicine, Hanover, NH
| | | | - Mitchell Grayson
- Nationwide Children's Hospital, The Ohio State University School of Medicine, Columbus, Ohio
| | - David Stukus
- Nationwide Children's Hospital, The Ohio State University School of Medicine, Columbus, Ohio
| | - Nicholas Hartog
- Spectrum Health Helen DeVos Children's Hospital, Grand Rapids, Mich
| | - Elena W Y Hsieh
- Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo
| | - Nicholas Rider
- The Texas Children's Hospital, Section of Immunology, Allergy, and Retrovirology and the Baylor College of Medicine, Houston, Texas
| | - Cullen M Dutmer
- Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo
| | - Timothy K Vander Leek
- Pediatric Allergy and Asthma, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Harold Kim
- Western University and McMaster University, London, ON, Canada
| | - Edmond S Chan
- BC Children's Hospital, The University of British Columbia, Vancouver, BC, Canada
| | - Doug Mack
- McMaster University, Hamilton, ON, Canada; Halton Pediatric Allergy, Burlington, ON, Canada
| | - Anne K Ellis
- Division of Allergy and Immunology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - David Lang
- Department of Medicine, Section of Allergy and Immunology, Cleveland Clinic, Cleveland, Ohio
| | - Jay Lieberman
- Division of Allergy and Immunology, The University of Tennessee, Memphis, Tenn
| | - David Fleischer
- Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo
| | - David B K Golden
- Division of Allergy and Clinical Immunology, John Hopkins University School of Medicine, Baltimore, Md
| | - Dana Wallace
- Nova Southeastern University College of Allopathic Medicine, Fort Lauderdale, Fla
| | - Jay Portnoy
- Children's Mercy, University of Missouri-Kansas City School of Medicine, Kansas City, Mo
| | - Giselle Mosnaim
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, NorthShore University Health System, Evanston, Ill
| | - Matthew Greenhawt
- Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo.
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