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Chee ML, Chee ML, Huang H, Mazzochi K, Taylor K, Wang H, Feng M, Ho AFW, Siddiqui FJ, Ong MEH, Liu N. Artificial intelligence and machine learning in prehospital emergency care: A scoping review. iScience 2023; 26:107407. [PMID: 37609632 PMCID: PMC10440716 DOI: 10.1016/j.isci.2023.107407] [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] [Indexed: 08/24/2023] Open
Abstract
Our scoping review provides a comprehensive analysis of the landscape of artificial intelligence (AI) applications in prehospital emergency care (PEC). It contributes to the field by highlighting the most studied AI applications and identifying the most common methodological approaches across 106 included studies. The findings indicate a promising future for AI in PEC, with many unique use cases, such as prognostication, demand prediction, resource optimization, and the Internet of Things continuous monitoring systems. Comparisons with other approaches showed AI outperforming clinicians and non-AI algorithms in most cases. However, most studies were internally validated and retrospective, highlighting the need for rigorous prospective validation of AI applications before implementation in clinical settings. We identified knowledge and methodological gaps using an evidence map, offering a roadmap for future investigators. We also discussed the significance of explainable AI for establishing trust in AI systems among clinicians and facilitating real-world validation of AI models.
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Affiliation(s)
- Marcel Lucas Chee
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Mark Leonard Chee
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Haotian Huang
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Katelyn Mazzochi
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Kieran Taylor
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Han Wang
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Mengling Feng
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Andrew Fu Wah Ho
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
- Pre-Hospital and Emergency Research Centre, Duke-NUS Medical School, Singapore, Singapore
| | - Fahad Javaid Siddiqui
- Pre-Hospital and Emergency Research Centre, Duke-NUS Medical School, Singapore, Singapore
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
- Pre-Hospital and Emergency Research Centre, Duke-NUS Medical School, Singapore, Singapore
| | - Nan Liu
- Pre-Hospital and Emergency Research Centre, Duke-NUS Medical School, Singapore, Singapore
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
- Institute of Data Science, National University of Singapore, Singapore, Singapore
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Lin S, Wang D, Sang H, Xiao H, Yan K, Wang D, Zhang Y, Yi L, Shao G, Shao Z, Yang A, Zhang L, Sun J. Predicting poststroke dyskinesia with resting-state functional connectivity in the motor network. NEUROPHOTONICS 2023; 10:025001. [PMID: 37025568 PMCID: PMC10072005 DOI: 10.1117/1.nph.10.2.025001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 03/17/2023] [Indexed: 06/19/2023]
Abstract
SIGNIFICANCE Motor function evaluation is essential for poststroke dyskinesia rehabilitation. Neuroimaging techniques combined with machine learning help decode a patient's functional status. However, more research is needed to investigate how individual brain function information predicts the dyskinesia degree of stroke patients. AIM We investigated stroke patients' motor network reorganization and proposed a machine learning-based method to predict the patients' motor dysfunction. APPROACH Near-infrared spectroscopy (NIRS) was used to measure hemodynamic signals of the motor cortex in the resting state (RS) from 11 healthy subjects and 31 stroke patients, 15 with mild dyskinesia (Mild), and 16 with moderate-to-severe dyskinesia (MtS). The graph theory was used to analyze the motor network characteristics. RESULTS The small-world properties of the motor network were significantly different between groups: (1) clustering coefficient, local efficiency, and transitivity: MtS > Mild > Healthy and (2) global efficiency: MtS < Mild < Healthy. These four properties linearly correlated with patients' Fugl-Meyer Assessment scores. Using the small-world properties as features, we constructed support vector machine (SVM) models that classified the three groups of subjects with an accuracy of 85.7%. CONCLUSIONS Our results show that NIRS, RS functional connectivity, and SVM together constitute an effective method for assessing the poststroke dyskinesia degree at the individual level.
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Affiliation(s)
- Shuoshu Lin
- Foshan University, School of Mechatronic Engineering and Automation, Foshan, China
| | - Dan Wang
- Beijing Rehabilitation Hospital of Capital Medical University, Department of Traditional Chinese Medicine, Beijing, China
| | - Haojun Sang
- Chinese Institute for Brain Research, Beijing, China
| | - Hongjun Xiao
- Foshan University, School of Mechatronic Engineering and Automation, Foshan, China
| | - Kecheng Yan
- Foshan University, School of Mechatronic Engineering and Automation, Foshan, China
| | - Dongyang Wang
- Foshan University, School of Mechatronic Engineering and Automation, Foshan, China
| | - Yizheng Zhang
- Foshan University, School of Mechatronic Engineering and Automation, Foshan, China
| | - Li Yi
- Foshan University, School of Mechatronic Engineering and Automation, Foshan, China
| | - Guangjian Shao
- Foshan University, School of Mechatronic Engineering and Automation, Foshan, China
| | - Zhiyong Shao
- Foshan University, School of Mechatronic Engineering and Automation, Foshan, China
| | - Aoran Yang
- Beijing Rehabilitation Hospital of Capital Medical University, Department of Traditional Chinese Medicine, Beijing, China
| | - Lei Zhang
- Chinese Institute for Brain Research, Beijing, China
- Capital Medical University, School of Biomedical Engineering, Beijing, China
| | - Jinyan Sun
- Foshan University, School of Medicine, Foshan, China
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Worlikar H, Coleman S, Kelly J, O'Connor S, Murray A, McVeigh T, Doran J, McCabe I, O'Keeffe D. Mixed Reality Platforms in Telehealth Delivery: Scoping Review. JMIR BIOMEDICAL ENGINEERING 2023; 8:e42709. [PMID: 38875694 PMCID: PMC11041465 DOI: 10.2196/42709] [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: 09/14/2022] [Revised: 11/03/2022] [Accepted: 11/16/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The distinctive features of the digital reality platforms, namely augmented reality (AR), virtual reality (VR), and mixed reality (MR) have extended to medical education, training, simulation, and patient care. Furthermore, this digital reality technology seamlessly merges with information and communication technology creating an enriched telehealth ecosystem. This review provides a composite overview of the prospects of telehealth delivered using the MR platform in clinical settings. OBJECTIVE This review identifies various clinical applications of high-fidelity digital display technology, namely AR, VR, and MR, delivered using telehealth capabilities. Next, the review focuses on the technical characteristics, hardware, and software technologies used in the composition of AR, VR, and MR in telehealth. METHODS We conducted a scoping review using the methodological framework and reporting design using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. Full-length articles in English were obtained from the Embase, PubMed, and Web of Science databases. The search protocol was based on the following keywords and Medical Subject Headings to obtain relevant results: "augmented reality," "virtual reality," "mixed-reality," "telemedicine," "telehealth," and "digital health." A predefined inclusion-exclusion criterion was developed in filtering the obtained results and the final selection of the articles, followed by data extraction and construction of the review. RESULTS We identified 4407 articles, of which 320 were eligible for full-text screening. A total of 134 full-text articles were included in the review. Telerehabilitation, telementoring, teleconsultation, telemonitoring, telepsychiatry, telesurgery, and telediagnosis were the segments of the telehealth division that explored the use of AR, VR, and MR platforms. Telerehabilitation using VR was the most commonly recurring segment in the included studies. AR and MR has been mainly used for telementoring and teleconsultation. The most important technical features of digital reality technology to emerge with telehealth were virtual environment, exergaming, 3D avatars, telepresence, anchoring annotations, and first-person viewpoint. Different arrangements of technology-3D modeling and viewing tools, communication and streaming platforms, file transfer and sharing platforms, sensors, high-fidelity displays, and controllers-formed the basis of most systems. CONCLUSIONS This review constitutes a recent overview of the evolving digital AR and VR in various clinical applications using the telehealth setup. This combination of telehealth with AR, VR, and MR allows for remote facilitation of clinical expertise and further development of home-based treatment. This review explores the rapidly growing suite of technologies available to users within the digital health sector and examines the opportunities and challenges they present.
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Affiliation(s)
- Hemendra Worlikar
- Health Innovation Via Engineering Laboratory, Cúram Science Foundation Ireland Research Centre for Medical Devices, University of Galway, Galway, Ireland
| | - Sean Coleman
- Health Innovation Via Engineering Laboratory, Cúram Science Foundation Ireland Research Centre for Medical Devices, University of Galway, Galway, Ireland
- Department of Medicine, University Hospital Galway, Galway, Ireland
| | - Jack Kelly
- Health Innovation Via Engineering Laboratory, Cúram Science Foundation Ireland Research Centre for Medical Devices, University of Galway, Galway, Ireland
- Department of Medicine, University Hospital Galway, Galway, Ireland
| | - Sadhbh O'Connor
- Health Innovation Via Engineering Laboratory, Cúram Science Foundation Ireland Research Centre for Medical Devices, University of Galway, Galway, Ireland
- Department of Medicine, University Hospital Galway, Galway, Ireland
| | - Aoife Murray
- Health Innovation Via Engineering Laboratory, Cúram Science Foundation Ireland Research Centre for Medical Devices, University of Galway, Galway, Ireland
| | - Terri McVeigh
- Cancer Genetics Unit, The Royal Marsden National Health Service Foundation Trust, London, United Kingdom
| | - Jennifer Doran
- Health Innovation Via Engineering Laboratory, Cúram Science Foundation Ireland Research Centre for Medical Devices, University of Galway, Galway, Ireland
| | - Ian McCabe
- Health Innovation Via Engineering Laboratory, Cúram Science Foundation Ireland Research Centre for Medical Devices, University of Galway, Galway, Ireland
| | - Derek O'Keeffe
- Department of Medicine, University Hospital Galway, Galway, Ireland
- School of Medicine, College of Medicine Nursing and Health Sciences, University of Galway, Galway, Ireland
- Lero, Science Foundation Ireland Centre for Software Research, University of Limerick, Limerick, Ireland
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Zhang Z, Bai E, Joy K, Ghelaa PN, Adelgais K, Ozkaynak M. Smart Glasses for Supporting Distributed Care Work: Systematic Review. JMIR Med Inform 2023; 11:e44161. [PMID: 36853760 PMCID: PMC10015357 DOI: 10.2196/44161] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/15/2023] [Accepted: 01/31/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Over the past 2 decades, various desktop and mobile telemedicine systems have been developed to support communication and care coordination among distributed medical teams. However, in the hands-busy care environment, such technologies could become cumbersome because they require medical professionals to manually operate them. Smart glasses have been gaining momentum because of their advantages in enabling hands-free operation and see-what-I-see video-based consultation. Previous research has tested this novel technology in different health care settings. OBJECTIVE The aim of this study was to review how smart glasses were designed, used, and evaluated as a telemedicine tool to support distributed care coordination and communication, as well as highlight the potential benefits and limitations regarding medical professionals' use of smart glasses in practice. METHODS We conducted a literature search in 6 databases that cover research within both health care and computer science domains. We used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology to review articles. A total of 5865 articles were retrieved and screened by 3 researchers, with 21 (0.36%) articles included for in-depth analysis. RESULTS All of the reviewed articles (21/21, 100%) used off-the-shelf smart glass device and videoconferencing software, which had a high level of technology readiness for real-world use and deployment in care settings. The common system features used and evaluated in these studies included video and audio streaming, annotation, augmented reality, and hands-free interactions. These studies focused on evaluating the technical feasibility, effectiveness, and user experience of smart glasses. Although the smart glass technology has demonstrated numerous benefits and high levels of user acceptance, the reviewed studies noted a variety of barriers to successful adoption of this novel technology in actual care settings, including technical limitations, human factors and ergonomics, privacy and security issues, and organizational challenges. CONCLUSIONS User-centered system design, improved hardware performance, and software reliability are needed to realize the potential of smart glasses. More research is needed to examine and evaluate medical professionals' needs, preferences, and perceptions, as well as elucidate how smart glasses affect the clinical workflow in complex care environments. Our findings inform the design, implementation, and evaluation of smart glasses that will improve organizational and patient outcomes.
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Affiliation(s)
- Zhan Zhang
- School of Computer Science and Information Systems, Pace University, New York, NY, United States
| | - Enze Bai
- School of Computer Science and Information Systems, Pace University, New York, NY, United States
| | - Karen Joy
- School of Computer Science and Information Systems, Pace University, New York, NY, United States
| | - Partth Naressh Ghelaa
- School of Computer Science and Information Systems, Pace University, New York, NY, United States
| | - Kathleen Adelgais
- School of Medicine, University of Colorado, Aurora, CO, United States
| | - Mustafa Ozkaynak
- College of Nursing, University of Colorado, Aurora, CO, United States
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Dinh A, Tseng E, Yin AL, Estrin D, Greenwald P, Fortenko A. Perceptions of Augmented Reality in Remote Medical Care: Interview Study of Emergency Telemedicine Providers (Preprint). JMIR Form Res 2022; 7:e45211. [PMID: 36976628 PMCID: PMC10131657 DOI: 10.2196/45211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Augmented reality (AR) and virtual reality (VR) have increasingly appeared in the medical literature in the past decade, with AR recently being studied for its potential role in remote health care delivery and communication. Recent literature describes AR's implementation in real-time telemedicine contexts across multiple specialties and settings, with remote emergency services in particular using AR to enhance disaster support and simulation education. Despite the introduction of AR in the medical literature and its potential to shape the future of remote medical services, studies have yet to investigate the perspectives of telemedicine providers regarding this novel technology. OBJECTIVE This study aimed to understand the applications and challenges of AR in telemedicine anticipated by emergency medicine providers with a range of experiences in using telemedicine and AR or VR technology. METHODS Across 10 academic medical institutions, 21 emergency medicine providers with variable exposures to telemedicine and AR or VR technology were recruited for semistructured interviews via snowball sampling. The interview questions focused on various potential uses of AR, anticipated obstacles that prevent its implementation in the telemedicine area, and how providers and patients might respond to its introduction. We included video demonstrations of a prototype using AR during the interviews to elicit more informed and complete insights regarding AR's potential in remote health care. Interviews were transcribed and analyzed via thematic coding. RESULTS Our study identified 2 major areas of use for AR in telemedicine. First, AR is perceived to facilitate information gathering by enhancing observational tasks such as visual examination and granting simultaneous access to data and remote experts. Second, AR is anticipated to supplement distance learning of both minor and major procedures and nonprocedural skills such as cue recognition and empathy for patients and trainees. AR may also supplement long-distance education programs and thereby support less specialized medical facilities. However, the addition of AR may exacerbate the preexisting financial, structural, and literacy barriers to telemedicine. Providers seek value demonstrated by extensive research on the clinical outcome, satisfaction, and financial benefits of AR. They also seek institutional support and early training before adopting novel tools such as AR. Although an overall mixed reception is anticipated, consumer adoption and awareness are key components in AR's adoption. CONCLUSIONS AR has the potential to enhance the ability to gather observational and medical information, which would serve a diverse set of applications in remote health care delivery and education. However, AR faces obstacles similar to those faced by the current telemedicine technology, such as lack of access, infrastructure, and familiarity. This paper discusses the potential areas of investigation that would inform future studies and approaches to implementing AR in telemedicine.
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Affiliation(s)
- Alana Dinh
- Medical College, Weill Cornell Medicine, New York, NY, United States
| | - Emily Tseng
- Department of Information Science, Cornell Tech, New York, NY, United States
| | - Andrew Lukas Yin
- Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Deborah Estrin
- Department of Computer Science, Cornell Tech, New York, NY, United States
| | - Peter Greenwald
- Emergency Medicine, NewYork-Presbyterian Hospital, New York, NY, United States
| | - Alexander Fortenko
- Emergency Medicine, NewYork-Presbyterian Hospital, New York, NY, United States
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Wilson K, Eaton J, Foye U, Ellis M, Thomas E, Simpson A. What evidence supports the use of Body Worn Cameras in mental health inpatient wards? A systematic review and narrative synthesis of the effects of Body Worn Cameras in public sector services. Int J Ment Health Nurs 2022; 31:260-277. [PMID: 34877792 PMCID: PMC9299804 DOI: 10.1111/inm.12954] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/28/2021] [Accepted: 11/07/2021] [Indexed: 12/27/2022]
Abstract
Body-Worn-Cameras (BWCs) are being introduced into Mental Health Inpatient Units. At present, minimal evidence surrounding their use in a mental health environment exists. This review examined research on the uses of BWCs in public sector services including healthcare, public transportation, and law enforcement. All eligible studies included a visible BWC, recording on a continuous loop as the main intervention. The evidence base presented high levels of bias, highly varied camera protocols, and heterogeneity of outcome measurements. This review found there is limited evidence for the efficacy of BWCs to control and manage violence within mental health inpatient wards. The technology has shown to be effective in reducing the number of public complaints in a law enforcement setting, but it is unclear how this is achieved. It appears there may be potential beneficial uses and unintended consequences of BWCs yet to be explored by mental health services.
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Affiliation(s)
- Keiran Wilson
- Health Services and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Jessica Eaton
- Great Ormond Street Hospital for Children, London, UK
| | - Una Foye
- Health Services and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Madeleine Ellis
- Health Services and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Ellen Thomas
- Health Services and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Alan Simpson
- Health Services and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Zhang Z, Joy K, Harris R, Ozkaynak M, Adelgais K, Munjal K. Applications and User Perceptions of Smart Glasses in Emergency Medical Services: Semistructured Interview Study. JMIR Hum Factors 2022; 9:e30883. [PMID: 35225816 PMCID: PMC8922155 DOI: 10.2196/30883] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 11/23/2021] [Accepted: 12/07/2021] [Indexed: 01/12/2023] Open
Abstract
Background Smart glasses have been gaining momentum as a novel technology because of their advantages in enabling hands-free operation and see-what-I-see remote consultation. Researchers have primarily evaluated this technology in hospital settings; however, limited research has investigated its application in prehospital operations. Objective The aim of this study is to understand the potential of smart glasses to support the work practices of prehospital providers, such as emergency medical services (EMS) personnel. Methods We conducted semistructured interviews with 13 EMS providers recruited from 4 hospital-based EMS agencies in an urban area in the east coast region of the United States. The interview questions covered EMS workflow, challenges encountered, technology needs, and users’ perceptions of smart glasses in supporting daily EMS work. During the interviews, we demonstrated a system prototype to elicit more accurate and comprehensive insights regarding smart glasses. Interviews were transcribed verbatim and analyzed using the open coding technique. Results We identified four potential application areas for smart glasses in EMS: enhancing teleconsultation between distributed prehospital and hospital providers, semiautomating patient data collection and documentation in real time, supporting decision-making and situation awareness, and augmenting quality assurance and training. Compared with the built-in touch pad, voice commands and hand gestures were indicated as the most preferred and suitable interaction mechanisms. EMS providers expressed positive attitudes toward using smart glasses during prehospital encounters. However, several potential barriers and user concerns need to be considered and addressed before implementing and deploying smart glasses in EMS practice. They are related to hardware limitations, human factors, reliability, workflow, interoperability, and privacy. Conclusions Smart glasses can be a suitable technological means for supporting EMS work. We conclude this paper by discussing several design considerations for realizing the full potential of this hands-free technology.
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Affiliation(s)
- Zhan Zhang
- School of Computer Science and Information Systems, Pace University, New York, NY, United States
| | - Karen Joy
- School of Computer Science and Information Systems, Pace University, New York, NY, United States
| | - Richard Harris
- School of Computer Science and Information Systems, Pace University, New York, NY, United States
| | - Mustafa Ozkaynak
- College of Nursing, University of Colorado, Aurora, CO, United States
| | - Kathleen Adelgais
- School of Medicine, University of Colorado, Aurora, CO, United States
| | - Kevin Munjal
- Department of Emergency Medicine, Mount Sinai Medical Center, New York, NY, United States
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Li W, Xu D. Application of intelligent rehabilitation equipment in occupational therapy for enhancing upper limb function of patients in the whole phase of stroke. MEDICINE IN NOVEL TECHNOLOGY AND DEVICES 2021. [DOI: 10.1016/j.medntd.2021.100097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Kandimalla J, Vellipuram AR, Rodriguez G, Maud A, Cruz-Flores S, Khatri R. Role of Telemedicine in Prehospital Stroke Care. Curr Cardiol Rep 2021; 23:71. [PMID: 33970356 DOI: 10.1007/s11886-021-01473-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/11/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW To summarize evidence for the feasibility and the efficacy of mobile stroke units (MSUs) and telemedicine in the field to reduce time delays in offering acute stroke interventions. RECENT FINDINGS A mobile stroke unit is a modified ambulance and includes sophisticated equipment, either trained personnel on board, or connection with skilled physicians via telemedicine. Stroke assessment and treatment agreeability between the on board and remote neurologist is high in MSUs. MSUs are the promising option to reduce stroke symptom onset to treatment time; telemedicine platform has a satisfactory audiovisual quality, high inter-rater reliability for remote stroke symptom assessment, diagnosis, and decision to treat. Use of MSU also avoids the need for inter-hospital transfers. MSUs improve prehospital stroke care and reduce delays in access to intravenous thrombolytic and mechanical thrombectomy in selective markets. Advancement in telecommunication and modern technology has the potential to make MSU telemedicine-aided management more cost-effective. Further research is needed before its widespread implementation.
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Affiliation(s)
- Jithendhar Kandimalla
- Department of Neurology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, 79905, USA
| | - Anantha R Vellipuram
- Department of Neurology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, 79905, USA
| | - Gustavo Rodriguez
- Department of Neurology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, 79905, USA
| | - Alberto Maud
- Department of Neurology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, 79905, USA
| | - Salvador Cruz-Flores
- Department of Neurology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, 79905, USA
| | - Rakesh Khatri
- Department of Neurology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, 79905, USA.
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Atashzar SF, Carriere J, Tavakoli M. Review: How Can Intelligent Robots and Smart Mechatronic Modules Facilitate Remote Assessment, Assistance, and Rehabilitation for Isolated Adults With Neuro-Musculoskeletal Conditions? Front Robot AI 2021; 8:610529. [PMID: 33912593 PMCID: PMC8072151 DOI: 10.3389/frobt.2021.610529] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 02/08/2021] [Indexed: 12/12/2022] Open
Abstract
Worldwide, at the time this article was written, there are over 127 million cases of patients with a confirmed link to COVID-19 and about 2.78 million deaths reported. With limited access to vaccine or strong antiviral treatment for the novel coronavirus, actions in terms of prevention and containment of the virus transmission rely mostly on social distancing among susceptible and high-risk populations. Aside from the direct challenges posed by the novel coronavirus pandemic, there are serious and growing secondary consequences caused by the physical distancing and isolation guidelines, among vulnerable populations. Moreover, the healthcare system's resources and capacity have been focused on addressing the COVID-19 pandemic, causing less urgent care, such as physical neurorehabilitation and assessment, to be paused, canceled, or delayed. Overall, this has left elderly adults, in particular those with neuromusculoskeletal (NMSK) conditions, without the required service support. However, in many cases, such as stroke, the available time window of recovery through rehabilitation is limited since neural plasticity decays quickly with time. Given that future waves of the outbreak are expected in the coming months worldwide, it is important to discuss the possibility of using available technologies to address this issue, as societies have a duty to protect the most vulnerable populations. In this perspective review article, we argue that intelligent robotics and wearable technologies can help with remote delivery of assessment, assistance, and rehabilitation services while physical distancing and isolation measures are in place to curtail the spread of the virus. By supporting patients and medical professionals during this pandemic, robots, and smart digital mechatronic systems can reduce the non-COVID-19 burden on healthcare systems. Digital health and cloud telehealth solutions that can complement remote delivery of assessment and physical rehabilitation services will be the subject of discussion in this article due to their potential in enabling more effective and safer NMSDK rehabilitation, assistance, and assessment service delivery. This article will hopefully lead to an interdisciplinary dialogue between the medical and engineering sectors, stake holders, and policy makers for a better delivery of care for those with NMSK conditions during a global health crisis including future pandemics.
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Affiliation(s)
- S. Farokh Atashzar
- Department of Electrical and Computer Engineering, Department of Mechanical and Aerospace Engineering, New York University, New York, NY, United States
| | - Jay Carriere
- Department of Electrical and Computer Engineering, University of Alberta, Edmonton, AB, Canada
| | - Mahdi Tavakoli
- Department of Electrical and Computer Engineering, University of Alberta, Edmonton, AB, Canada
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Noorian AR. Prehospital EMS Triage for Acute Stroke Care. Semin Neurol 2021; 41:5-8. [PMID: 33506476 DOI: 10.1055/s-0040-1722725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Acute stroke has had major advances over the last two decades due to the introduction of pharmacologic and endovascular revascularization, which can improve functional outcome. Stroke systems of care have been developed to provide faster, more efficient care for stroke patients. A major part of these care pathways is prehospital care, when patients are triaged to appropriate levels of care. It is essential that prehospital scales are used accurately and effectively by emergency medical services to assist them with the triage process. New technologies including mobile stroke units, telemedicine, and wearable technology have been introduced as options for optimization of this emergent process.
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Affiliation(s)
- Ali Reza Noorian
- Department of Neurology, Kaiser Permanente Orange County, Irvine, California
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Bechstein M, Elsheikh S, Wodarg F, Taschner CA, Hanning U, Buhk JH, McDonough R, Goebell E, Fiehler J, Bester M. Republished: Interhospital teleproctoring of endovascular intracranial aneurysm treatment using a dedicated live-streaming technology: first experiences during the COVID-19 pandemic. J Neurointerv Surg 2020; 13:e1. [PMID: 33082292 PMCID: PMC7848056 DOI: 10.1136/neurintsurg-2020-016722.rep] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/02/2020] [Accepted: 09/04/2020] [Indexed: 12/19/2022]
Abstract
This is a report of the first three cases of endovascular aneurysm treatment that were proctored by a remote interventionalist using a novel high-resolution low-latency streaming technology. The proctor was located in a neurovascular centre and supported the treating interventional teams in two distant cities (up to 800 km/500 miles apart). All aneurysms were treated using the Woven EndoBridge (WEB) embolisation system, either electively or following subarachnoid haemorrhage. On-site proctoring was not possible due to travel restrictions during the COVID-19 pandemic. WEB placement was feasible in all cases. Good rapport between proctors and treating physicians was reported, enabled by the high-resolution image transmission and uninterrupted feedback/discussion via audiostream. No clinical complications were encountered. Short-term follow-up revealed adequate occlusion of all treated aneurysms. The employed streaming technology provided effective remote proctoring during complex aneurysm cases, including the management of technical complications.
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Affiliation(s)
- Matthias Bechstein
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Samer Elsheikh
- Department of Neuroradiology, University Medical Center Freiburg, Freiburg, Germany
| | - Fritz Wodarg
- Department of Radiology and Neuroradiology, Universitätsklinikum Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Christian A Taschner
- Department of Neuroradiology, University Medical Center Freiburg, Freiburg, Germany
| | - Uta Hanning
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan-Hendrik Buhk
- Neuroradiology, Asklepios Hospitals St. Georg and Wandsbek, Hamburg, Germany
| | - Rosalie McDonough
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Einar Goebell
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maxim Bester
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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13
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Bechstein M, Elsheikh S, Wodarg F, Taschner CA, Hanning U, Buhk JH, McDonough R, Goebell E, Fiehler J, Bester M. Interhospital teleproctoring of endovascular intracranial aneurysm treatment using a dedicated live-streaming technology: first experiences during the COVID-19 pandemic. BMJ Case Rep 2020; 13:13/10/e016722. [PMID: 33012707 PMCID: PMC7536784 DOI: 10.1136/bcr-2020-016722] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
This is a report of the first three cases of endovascular aneurysm treatment that were proctored by a remote interventionalist using a novel high-resolution low-latency streaming technology. The proctor was located in a neurovascular centre and supported the treating interventional teams in two distant cities (up to 800 km/500 miles apart). All aneurysms were treated using the Woven EndoBridge (WEB) embolisation system, either electively or following subarachnoid haemorrhage. On-site proctoring was not possible due to travel restrictions during the COVID-19 pandemic. WEB placement was feasible in all cases. Good rapport between proctors and treating physicians was reported, enabled by the high-resolution image transmission and uninterrupted feedback/discussion via audiostream. No clinical complications were encountered. Short-term follow-up revealed adequate occlusion of all treated aneurysms. The employed streaming technology provided effective remote proctoring during complex aneurysm cases, including the management of technical complications.
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Affiliation(s)
- Matthias Bechstein
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Samer Elsheikh
- Department of Neuroradiology, University Medical Center Freiburg, Freiburg, Germany
| | - Fritz Wodarg
- Department of Radiology and Neuroradiology, Universitätsklinikum Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Christian A Taschner
- Department of Neuroradiology, University Medical Center Freiburg, Freiburg, Germany
| | - Uta Hanning
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan-Hendrik Buhk
- Neuroradiology, Asklepios Hospitals St. Georg and Wandsbek, Hamburg, Germany
| | - Rosalie McDonough
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Einar Goebell
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maxim Bester
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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14
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Bang OY. Coronavirus disease in 2020 and Precision and Future Medicine. PRECISION AND FUTURE MEDICINE 2020. [DOI: 10.23838/pfm.2020.00135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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15
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Pineau G, Jenvrin J, Péré M, Penverne Y, Montassier E, Martinage A. Videoconferencing in the emergency medical dispatch center: A pilot study. Am J Emerg Med 2020; 41:257-258. [PMID: 32601007 DOI: 10.1016/j.ajem.2020.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/03/2020] [Accepted: 06/03/2020] [Indexed: 10/24/2022] Open
Affiliation(s)
- Gwenolé Pineau
- Department of Emergency Medicine, SAMU44, CHU Nantes, 44000 Nantes, France
| | - Joël Jenvrin
- Department of Emergency Medicine, SAMU44, CHU Nantes, 44000 Nantes, France
| | - Morgane Péré
- Direction de la recherche Plateforme de Méthodologie et Biostatistique, CHU de Nantes, 44000 Nantes, France
| | - Yann Penverne
- Department of Emergency Medicine, SAMU44, CHU Nantes, 44000 Nantes, France
| | | | - Arnaud Martinage
- Department of Emergency Medicine, SAMU44, CHU Nantes, 44000 Nantes, France
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16
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Daggubati LC, Eichberg DG, Ivan ME, Hanft S, Mansouri A, Komotar RJ, D'Amico RS, Zacharia BE. Telemedicine for Outpatient Neurosurgical Oncology Care: Lessons Learned for the Future During the COVID-19 Pandemic. World Neurosurg 2020; 139:e859-e863. [PMID: 32450309 PMCID: PMC7243783 DOI: 10.1016/j.wneu.2020.05.140] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 05/15/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND The coronavirus 2019 (COVD-19) pandemic has drastically disrupted the delivery of neurosurgical care, especially for the already at-risk neuro-oncology population. The sudden change to clinic visits has rapidly spurned the implementation of telemedicine. A recommendation care paradigm of neuro-oncologic patients limited by telemedicine has not been reported. METHODS A summary of a multi-institution experience detailing the potential benefits, pitfalls, and the necessary considerations to outpatient care of neurosurgical oncology patients. RESULTS There are limitations and advantages to incorporating telemedicine into the outpatient care of neuro-oncology patients. Telemedicine-specific considerations for each step and stakeholder of the appointment (physician, patient, scheduling, previsit, imaging, and physical examination) are examined. CONCLUSIONS Telemedicine, pushed to prominence during this COVID-19 pandemic, is a powerful and possibly preferential tool for the future of outpatient neuro-oncologic care.
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Affiliation(s)
- Lekhaj C Daggubati
- Department of Neurosurgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania, USA
| | - Daniel G Eichberg
- Department of Neurosurgery, University of Miami, Miami, Florida, USA
| | - Michael E Ivan
- Department of Neurosurgery, University of Miami, Miami, Florida, USA; Sylvester Comprehensive Cancer Center, Miami, Florida, USA
| | - Simon Hanft
- Department of Neurosurgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Alireza Mansouri
- Department of Neurosurgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania, USA; Penn State Cancer Institute, Hershey, Pennsylvania, USA
| | - Ricardo J Komotar
- Department of Neurosurgery, University of Miami, Miami, Florida, USA; Sylvester Comprehensive Cancer Center, Miami, Florida, USA
| | - Randy S D'Amico
- Department of Neurosurgery, Lenox Hill Hospital/Northwell Health, New York, New York, USA
| | - Brad E Zacharia
- Department of Neurosurgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania, USA; Penn State Cancer Institute, Hershey, Pennsylvania, USA.
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