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Tan AJQ, McKenna L, Bramley A, van Houwelingen T, Tan LLC, Lim YJ, Lau ST, Liaw SY. Telemedicine entrustable professional activities for nurses in long-term care: A modified Delphi study. NURSE EDUCATION TODAY 2024; 140:106264. [PMID: 38823089 DOI: 10.1016/j.nedt.2024.106264] [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: 10/28/2023] [Revised: 04/04/2024] [Accepted: 05/23/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND As the use of telemedicine proliferates in community care, it is essential to ensure practice recommendations and guidelines are available to assist healthcare providers in providing telemedicine-based care. This study aimed to develop entrustable professional activities (EPAs) for nursing home nurses involved in telemedicine consultations. AIM To develop entrustable professional activities (EPAs) for nursing home nurses involved in telemedicine consultations. DESIGN Modified Delphi study. METHODS The study was conducted in two stages. First, content analysis of 28 healthcare provider interviews and literature review on telemedicine competencies was conducted to develop an initial list of EPAs. An expert workgroup comprising of an international panel of academics and clinicians reviewed the activities. In the second stage, a three-round e-Delphi technique was used to develop telemedicine EPAs for nurses in long-term care. Descriptive statistics and qualitative feedback were distributed to participants after each round. Agreement within survey rounds was computed. RESULTS Six core telemedicine EPAs with 28 descriptors were developed, from preparing the resident for the teleconsultation encounter to follow-up care post-teleconsultation. Agreement coefficients were high across all Delphi rounds. CONCLUSION This study identifies the core functions that long-term care nurses' are expected to perform in telemedicine consultations. The internationally relevant EPAs are sufficiently broad to be adapted to design telemedicine training and workplace-based assessment for nurses. Organisations may utilise the EPAs as a resource during the implementation process of telemedicine services in long-term care in designing nursing workflow and complement the learning and development of nurses for telemedicine services. Equipping long-term care nurses with this resource can ensure consistency, patient safety and quality of teleconsultations delivered to nursing home residents. However, further work is required to expand the EPAs for application to practice.
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Affiliation(s)
- Apphia Jia Qi Tan
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Lisa McKenna
- School of Nursing and Midwifery, La Trobe University, Australia
| | - Andrea Bramley
- Department of Dietetics, Nutrition and Sport, School of Allied Health, Human Service, and Sport, La Trobe University, Australia; Monash Health, Clayton, Victoria, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
| | - Thijs van Houwelingen
- Research Group Technology for Healthcare Innovations, Research Centre for Healthy and Sustainable Living, University of Applied Sciences Utrecht, The Netherlands
| | - Laurence Lean Chin Tan
- Division of Palliative Care and Supportive Care, Department of Geriatric Medicine, Yishun Health, Singapore; Population Health Campus, National Healthcare Group, Singapore
| | - Yu Jun Lim
- Population Health Campus, National Healthcare Group, Singapore
| | - Siew Tiang Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Sok Ying Liaw
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Tsang WN, Lee JJ, Yang SC, Poon JCY, Lau EYY. Stroke caregivers' perception on instant messaging application use for psychological intervention: a qualitative study. PSYCHOL HEALTH MED 2024; 29:1208-1221. [PMID: 38528430 DOI: 10.1080/13548506.2024.2332925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 03/15/2024] [Indexed: 03/27/2024]
Abstract
In caring for patients with stroke, the leading cause of death and disability affecting over 80 million people worldwide, caregivers experience substantial psychological and physical burdens and difficulties in help-seeking owing to physical and time-constraints. Social distancing measures imposed during the coronavirus disease 2019 (COVID-19) pandemic further restricted them from using caregiver support services. While the use of telehealth emerged as a global prevailing trend during the COVID-19 pandemic, evidence for utilising instant messaging (IM) applications for psychological intervention is scanty. This study aimed to explore stroke caregivers' perceived potential utility of IM-delivered psychological intervention. Between January and August 2020, 36 adult family stroke caregivers in Hong Kong were recruited to individual telephone semi-structured interviews using purposive sampling. The interviews were audio-recorded, transcribed verbatim and analysed using an interpretive description approach. Three themes of caregivers' perceptions towards IM-delivered psychological intervention emerged: perceived high convenience and ease of use, perceived advantages that overcome existing barriers to services and message delivery tailored to individual needs. Our findings suggested that there is an imminent need among stroke caregivers for personalised psychological interventions and that IM is a potential modality for overcoming existing barriers in delivering accessible support to caregivers in real-time, real-world settings. Our study highlighted caregivers' acceptance and perceived benefits of IM-delivered psychological intervention and provided practical insights into the design of IM-delivered psychological interventions.
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Affiliation(s)
- Wing Nga Tsang
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, SAR
| | - Jung Jae Lee
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, SAR
| | - Sook Ching Yang
- Department of Medicine, St Vincent's Hospital, Sydney, Australia
| | - Joan Chung Yan Poon
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, SAR
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Hussain KHH, Al Shmanee MZ, Taha FH, Samara KA, Barqawi HJ, Dash NR. Perception, Usability, and Satisfaction with Telemedicine in the United Arab Emirates. Telemed J E Health 2024. [PMID: 39072672 DOI: 10.1089/tmj.2024.0207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024] Open
Abstract
Background: Telemedicine has become a global tool for enhancing health care accessibility. However, its widespread adoption is still limited by technological illiteracy, lack of appropriate devices, slow internet services, and privacy concerns. In the Middle East and North Africa, including the United Arab Emirates (UAE), there is a dearth of telemedicine research. This study aimed to understand the perceptions and satisfaction levels of the UAE population regarding telemedicine. Methods: Between June and September 2023, a cross-sectional study was undertaken, using an online questionnaire distributed among UAE citizens and residents aged 18 years and above. The survey aimed to gauge the perceptions, usability, and satisfaction levels of telemedicine users, alongside identifying barriers hindering its acceptance. Data analysis was performed using Python 3, using Matplotlib v3.3.4 and Pandas v1.2. Results: The data analysis encompassed 1,013 participants, among whom 66.9% (678/1,013) were familiar with telemedicine. From this group, 29.8% (202/678) had previously utilized it. Of these users, 92.3% (186/202) found it to be useful or highly useful, whereas 83.1% (168/202) expressed overall satisfaction with their telemedicine experience. Among those who had not used telemedicine (47%, 476/1,013), the predominant concerns were a preference for in-person health care consultations for better care (77%, 367/476) and uncertainty about the quality of care offered through telemedicine (62%, 296/476). Conclusions: Despite high awareness of telemedicine in the UAE, its actual usage remains limited, highlighting the necessity for increased promotional efforts. Nevertheless, positive feedback suggests considerable potential for broad adoption. Future studies should address participants' concerns to enhance telemedicine utilization in the region.
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Affiliation(s)
| | - Marwah Zakariya Al Shmanee
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
- Dubai Health Authority, Dubai, Unites Arab Emirates
| | - Fatima Husni Taha
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
- American Hospital Dubai, Dubai, United Arab Emirates
| | - Kamel Aladdein Samara
- Clinical Sciences Department, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Hiba Jawdat Barqawi
- Clinical Sciences Department, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Nihar Ranjan Dash
- Clinical Sciences Department, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
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4
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Cui F, Zhang X, He X, Liu D, Shi J, Ye M, Wang L, Chu Y, Zhao J. Clinical applications of telemedicine services using a regional telemedicine platform for cancer treatment: a cross-sectional study. BMC Cancer 2024; 24:808. [PMID: 38973010 PMCID: PMC11229255 DOI: 10.1186/s12885-024-12563-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 06/25/2024] [Indexed: 07/09/2024] Open
Abstract
BACKGROUND Telemedicine is beneficial for improving treatment efficiency and reducing medical expenses of cancer patients. This study focuses on cancer patients participating in teleconsultations through a regional telemedicine platform in China, analyzes the consultation process, and provides references for the clinical application of telemedicine. METHODS We collected information on teleconsultations of cancer patients conducted from 2015 to 2022 through the regional telemedicine platform. Utilizing SPSS 23.0 software, we conducted descriptive analysis to summarize the distribution of patient gender, age, region, and disease types. The ordinal logistic regression analysis was adopted to analyze the factors influencing the waiting time and consultation duration for teleconsultations. RESULTS From 2015 to 2022, a total of 23,060 teleconsultations were conducted for cancer patients via regional telemedicine platform, with an average growth rate of 11.09%. The main types of consultations were for lung cancer, liver cancer, and breast cancer, accounting for 18.14%, 10.49%, and 9.46% respectively. 57.05% of teleconsultations had a waiting time of less than 24 h, while patient age, consultation expert level, and disease type were the main factors influencing the waiting time. 50.06% of teleconsultations had a duration of more than 20 min, and the inviting hospital level and the title of invited consultant were the main factors influencing the consultation duration. CONCLUSIONS In China, telemedicine has been widely employed in the clinical diagnosis and treatment of cancers, covering various types of oncological diseases. However, the waiting time for teleconsultations was generally more than 12 h, indicating the need to enhance consultation scheduling and allocate more expert resources to further optimize the efficiency of teleconsultations. Additionally, further exploration is required for remote health management of outpatients with cancers outside the hospital.
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Affiliation(s)
- Fangfang Cui
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe Road, Erqi District, Zhengzhou, 450052, Henan, China
| | - Xu Zhang
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe Road, Erqi District, Zhengzhou, 450052, Henan, China
| | - Xianying He
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe Road, Erqi District, Zhengzhou, 450052, Henan, China
| | - Dongqing Liu
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe Road, Erqi District, Zhengzhou, 450052, Henan, China
| | - Jinming Shi
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe Road, Erqi District, Zhengzhou, 450052, Henan, China
| | - Ming Ye
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe Road, Erqi District, Zhengzhou, 450052, Henan, China
| | - Linlin Wang
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe Road, Erqi District, Zhengzhou, 450052, Henan, China
| | - Yuntian Chu
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe Road, Erqi District, Zhengzhou, 450052, Henan, China
| | - Jie Zhao
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe Road, Erqi District, Zhengzhou, 450052, Henan, China.
- Shanghai Artificial Intelligence Laboratory, Shanghai, China.
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O'Connor M, Moore T, Zhong Y. Using telehealth for people at the end of life with chronic illness in Australia. Int J Palliat Nurs 2024; 30:398-403. [PMID: 39028316 DOI: 10.12968/ijpn.2024.30.7.398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
BACKGROUND Traditional models of palliative care have been tested by the challenges of caring for increasing numbers of people at the end stages of a chronic non-malignant illness. The COVID-19 pandemic and consequent reliance on telehealth services, has enabled the development of creative models of care. AIMS To improve home-based palliative care for people with chronic illness using telehealth, and this was demonstrated using quality-of-life measures. METHODS A total of 35 non-cancer referrals to a community palliative care service were recommended for the pilot project, with one specialist palliative care nurse as their contact. All were offered a telehealth service with a specially designed app to self-monitor their symptoms, a session on advance care directives, and self-rated quality-of-life measures using the RAND 36-Item Health Survey (Version 1.0), consisting of 36 items that cover nine domains. Statistical analysis was performed using SPSS software. FINDINGS Over the 21 months of the pilot study, 13 people chose to participate in the pilot. For participants, telehealth meant more control over their symptoms, fewer emergency presentations and appointment travel time was alleviated. Quality-of-life surveys highlighted physical impairments, which did not change over time. CONCLUSION This pilot programme demonstrated an innovative approach to addressing the demands of people dying of chronic illness, with further work required to explore the place of telehealth consultations in the overall healthcare system.
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Affiliation(s)
| | - Tim Moore
- Palliative care Clinical Nurse Consultant, Melbourne City Mission, Palliative Care, Australia
| | - Yaping Zhong
- Research Fellow, Nursing and Midwifery, Monash University, Australia
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González MP, Scartascini C. Increasing the use of telemedicine: A field experiment. PNAS NEXUS 2024; 3:pgae239. [PMID: 38966011 PMCID: PMC11223656 DOI: 10.1093/pnasnexus/pgae239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 05/25/2024] [Indexed: 07/06/2024]
Abstract
Patients are reluctant to use telemedicine health services, compared to its substitute in-person visits. One reason is that telemedicine can be accurately evaluated and compared to its substitute only after the product has been adopted and experienced. As such, an intervention that increases the probability of a first experience can have lasting effects. This article reports the results of a randomized field experiment conducted in collaboration with a health insurance company. During the intervention, half of the households out of 3,469 in the sample received periodic e-mails with information about the available services. It effectively increased the take-up and demand for telemedicine. Within the first 8 months of the experiment, patients assigned to the treatment group were 6 percentage points more likely to have used the service at least once (and had about five times the odds of using telemedicine compared to those in the control group). Eight months after the start of the intervention, the number of virtual consultations by the treatment group was six times larger than that of the control group. These results, even if limited by the sample and context in which the intervention took place, provide additional evidence about how information interventions can increase technological take-up within the health sector and could serve as the stepping stone for evaluating the impact of telemedicine on health outcomes causally.
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Affiliation(s)
- Maria Patricia González
- Digital Inclusion Benchmarks, World Benchmarking Alliance, Prins Hendrikkade 25, 1012 TM Amsterdam, Netherlands
| | - Carlos Scartascini
- Research Department, Inter-American Development Bank, 1300 New York Ave., NW, Washington, DC 20577, USA
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Baron R, Haick H. Mobile Diagnostic Clinics. ACS Sens 2024; 9:2777-2792. [PMID: 38775426 PMCID: PMC11217950 DOI: 10.1021/acssensors.4c00636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 05/06/2024] [Accepted: 05/10/2024] [Indexed: 06/29/2024]
Abstract
This article reviews the revolutionary impact of emerging technologies and artificial intelligence (AI) in reshaping modern healthcare systems, with a particular focus on the implementation of mobile diagnostic clinics. It presents an insightful analysis of the current healthcare challenges, including the shortage of healthcare workers, financial constraints, and the limitations of traditional clinics in continual patient monitoring. The concept of "Mobile Diagnostic Clinics" is introduced as a transformative approach where healthcare delivery is made accessible through the incorporation of advanced technologies. This approach is a response to the impending shortfall of medical professionals and the financial and operational burdens conventional clinics face. The proposed mobile diagnostic clinics utilize digital health tools and AI to provide a wide range of services, from everyday screenings to diagnosis and continual monitoring, facilitating remote and personalized care. The article delves into the potential of nanotechnology in diagnostics, AI's role in enhancing predictive analytics, diagnostic accuracy, and the customization of care. Furthermore, the article discusses the importance of continual, noninvasive monitoring technologies for early disease detection and the role of clinical decision support systems (CDSSs) in personalizing treatment guidance. It also addresses the challenges and ethical concerns of implementing these advanced technologies, including data privacy, integration with existing healthcare infrastructure, and the need for transparent and bias-free AI systems.
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Affiliation(s)
- Roni Baron
- Department
of Biomedical Engineering, Technion—Israel
Institute of Technology, Haifa 3200003, Israel
| | - Hossam Haick
- Department
of Chemical Engineering and the Russell Berrie Nanotechnology Institute, Technion—Israel Institute of Technology, Haifa 3200003, Israel
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8
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Ojong SA, Temmerman M, Khosla R, Bustreo F. Women's health and rights in the twenty-first century. Nat Med 2024; 30:1547-1555. [PMID: 38886622 DOI: 10.1038/s41591-024-03036-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 04/30/2024] [Indexed: 06/20/2024]
Abstract
In the twenty-first century, the complex relationship between women's health and rights has been influenced by a range of interconnected challenges, including gender inequity, reproductive health disparities, maternal mortality and morbidity, and women's inability to access life-saving, high-quality healthcare services including family planning. Going forward, the world needs to find ways to implement the unfinished agenda of the International Conference on Population and Development (ICPD) 1994 and the Sustainable Development Goals (SDGs), thus prioritizing health and rights for women and girls as essential not only to their survival but also to their progress, agency and empowerment. It is also important to consider the interconnection between women's health and rights and climate change, with its disproportionate impact on the well-being of girls and women, and to address the impact and opportunities afforded by digital technologies. By embracing a holistic approach, societies might be able to advance the cause of women's health and rights in a more inclusive and sustainable manner.
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Affiliation(s)
| | - Marleen Temmerman
- Centre of Excellence in Women and Child Health, East Africa, Aga Khan University, Nairobi, Kenya.
- Partnership for Maternal, Newborn and Child Health, Geneva, Switzerland.
| | - Rajat Khosla
- International Institute on Global Health, United Nations University, Kuala Lumpur, Malaysia
| | - Flavia Bustreo
- Partnership for Maternal, Newborn and Child Health, Geneva, Switzerland
- Fondation Botnar Board, Basel, Switzerland
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Fang J, Zhou W, Hayes DK, Wall HK, Wozniak G, Chung A, Loustalot F. Changes in Self-Measured Blood Pressure Monitoring Use in 14 States From 2019 to 2021: Impact of the COVID-19 Pandemic. Am J Hypertens 2024; 37:421-428. [PMID: 38483188 DOI: 10.1093/ajh/hpae031] [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: 10/16/2023] [Revised: 01/17/2024] [Accepted: 03/10/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Self-measured blood pressure monitoring (SMBP) is an important out-of-office resource that is effective in improving hypertension control. Changes in SMBP use during the Coronavirus Disease 2019 (COVID-19) pandemic have not been described previously. METHODS Behavioral Risk Factor Surveillance System (BRFSS) data were used to quantify changes in SMBP use between 2019 (prior COVID-19 pandemic) and 2021 (during the COVID-19 pandemic). Fourteen states administered the SMBP module in both years. All data were self-reported from adults who participated in the BRFSS survey. We assessed the receipt of SMBP recommendations from healthcare professionals and actual use of SMBP among those with hypertension (n = 68,820). Among those who used SMBP, we assessed SMBP use at home and sharing BP readings electronically with healthcare professionals. RESULTS Among adults with hypertension, there was no significant changes between 2019 and 2021 in those reporting SMBP use (57.0% vs. 55.7%) or receiving recommendations from healthcare professionals to use SMBP (66.4% vs. 66.8%). However, among those who used SMBP, there were significant increases in use at home (87.7% vs. 93.5%) and sharing BP readings electronically (8.6% vs. 13.1%) from 2019 to 2021. Differences were noted by demographic characteristics and residence state. CONCLUSIONS Receiving a recommendation from the healthcare provider to use SMBP and actual use did not differ before and during the COVID-19 pandemic. However, among those who used SMBP, home use and sharing BP readings electronically with healthcare professional increased significantly, although overall sharing remained low (13.1%). Maximizing advances in virtual connections between clinical and community settings should be leveraged for improved hypertension management.
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Affiliation(s)
- Jing Fang
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Wen Zhou
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Donald K Hayes
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Hilary K Wall
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Gregory Wozniak
- Improving Health Outcomes, American Medical Association, Chicago, Illinois, USA
| | - Alina Chung
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Fleetwood Loustalot
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Prosperi Desenzi Ciaralo P, Guerreiro Cardoso PF, Minamoto H, Bibas BJ, Ribeiro de Carvalho CR, Pego-Fernandes PM. Implementation and Results of a Dedicated Telemedicine Program ( TeleTrachea) for Patients with Tracheal Diseases. Telemed J E Health 2024; 30:1317-1324. [PMID: 38109228 DOI: 10.1089/tmj.2023.0524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2023] Open
Abstract
Background: Central airway diseases requiring frequent outpatient visits to a specialized medical center due to tracheal devices. Many of these patients have mobility and cognition restrictions or require specialized transport due to the need for supplemental oxygen. This study describes the implementation and results of a telemedicine program dedicated to patients with central airway diseases based in a Brazilian public health system. Methods: A retrospective study of telemedicine consultation for patients with central airway diseases referred to a public academic hospital between August 1, 2020 and August 1, 2022. The consultations occurred in a telemedicine department using the hospital's proprietary platform. Data retrieved consisted of demographics, disease characteristics, and the treatment modalities of the patients. The analysis included the savings in kilometers not traveled, the carbon footprint based on reducing CO2 emissions, and the cost savings in transportation. Results: A total of 1,153 telemedicine visits conducted in 516 patients (median age of 31.5 years). Two hundred ninety patients (56.2%) had a tracheal device (129 silicone T-Tube, 128 tracheostomy, and 33 endoprosthesis) and 159 patients (30.8%) had difficulties in transportation to the specialized medical center. Patients were served from 147 Brazilian cities from 22 states. The savings in kilometers traveled was 1,224,108.54 km, corresponding to a 250.14 ton reduction in CO2 emissions. The costs savings in transportation for the municipalities was BRL$ 1,272,283.78. Conclusions: Telemedicine consultations for patients with central airway diseases are feasible and safe. Cost savings and the possibility of disseminating specialized care make telemedicine a fundamental tool in current medical practice.
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Affiliation(s)
- Pedro Prosperi Desenzi Ciaralo
- Divisions of Thoracic Surgery, Instituto do Coracao do Hospital das Clinicas, HCFMUSP da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil
| | - Paulo Francisco Guerreiro Cardoso
- Divisions of Thoracic Surgery, Instituto do Coracao do Hospital das Clinicas, HCFMUSP da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil
| | - Helio Minamoto
- Divisions of Thoracic Surgery, Instituto do Coracao do Hospital das Clinicas, HCFMUSP da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil
| | - Benoit Jacques Bibas
- Divisions of Thoracic Surgery, Instituto do Coracao do Hospital das Clinicas, HCFMUSP da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil
| | - Carlos Roberto Ribeiro de Carvalho
- Divisions of Pulmonology, Instituto do Coracao do Hospital das Clinicas, HCFMUSP da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil
| | - Paulo Manuel Pego-Fernandes
- Divisions of Thoracic Surgery, Instituto do Coracao do Hospital das Clinicas, HCFMUSP da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil
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11
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Sabesan V, Ogunfuwa F, Grunhut J, Sommerville S, Fomunung C, Elkhechen J, Fernandez C, Lavin A, Jackson GR. Telemedicine in orthopaedics during the COVID-19 pandemic: a comparative landscape. INTERNATIONAL ORTHOPAEDICS 2024; 48:1149-1155. [PMID: 38367059 DOI: 10.1007/s00264-024-06098-4] [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: 09/10/2023] [Accepted: 01/18/2024] [Indexed: 02/19/2024]
Abstract
PURPOSE The purpose of this study was to provide a comprehensive analysis on observed trends regarding the impact of the COVID-19 pandemic on telemedicine application in orthopaedics compared to other procedural, non-emergent specialties. METHODS This was a retrospective review of all telemedicine and in-person visits at a large single institution from January to December 2020. The number of patient visits, visit type, location, and provider specifics were collected. Comparisons were made between subspecialties (orthopaedic surgery, oncology, family medicine, rheumatology) for analyses. RESULTS All specialties included were not conducting virtual visits at the beginning of 2020. By April 2020, orthopaedic virtual visits spiked to an all-time high of 33.5% of all patient visits as compared to oncology at 25.5%, rheumatology at 92.9%, and family medicine at 94%. By the end of the study period, orthopaedic virtual visits decreased back down to 6.5% of patient visits compared to oncology at 7.0%, and family medicine (17.4%) and rheumatology (26.2%). Orthopaedic providers practicing greater than 20 years had the highest average virtual visit rates. CONCLUSION Although the COVID-19 pandemic has posed unique challenges for healthcare providers, there was a great advancement in the rollout and application of telemedicine. To mitigate the spread of infection from coronavirus and given the recent adjustments to reimbursement policies and HIPAA regulations, orthopaedics saw a dramatic expansion of telemedicine since April 2020. The pandemic may have served as a catalyst to adopt telehealth into clinical practice. However, telehealth saw a downtrend trend by December 2020, particularly in procedure-based fields like orthopaedics and oncology.
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Affiliation(s)
- Vani Sabesan
- Palm Beach Shoulder Service HCA FL - Atlantis Orthopaedics, 900 Village Square Crossing Suite 170, Palm Beach, FL, USA.
- HCA JFK/University of Miami Miller School of Medicine Orthopaedic Surgery Residency Program, Palm Beach, FL, USA.
- Levitetz Dept of Orthopedic Surgery, Cleveland Clinic Florida, Weston, FL, USA.
| | - Feyikemi Ogunfuwa
- Charles E. Schmidt College of Medicine at, Florida Atlantic University, Boca Raton, FL, USA
| | - Joel Grunhut
- Charles E. Schmidt College of Medicine at, Florida Atlantic University, Boca Raton, FL, USA
| | - Shad Sommerville
- Charles E. Schmidt College of Medicine at, Florida Atlantic University, Boca Raton, FL, USA
| | - Clyde Fomunung
- Palm Beach Shoulder Service HCA FL - Atlantis Orthopaedics, 900 Village Square Crossing Suite 170, Palm Beach, FL, USA
- HCA JFK/University of Miami Miller School of Medicine Orthopaedic Surgery Residency Program, Palm Beach, FL, USA
| | - Justin Elkhechen
- Palm Beach Shoulder Service HCA FL - Atlantis Orthopaedics, 900 Village Square Crossing Suite 170, Palm Beach, FL, USA
- HCA JFK/University of Miami Miller School of Medicine Orthopaedic Surgery Residency Program, Palm Beach, FL, USA
| | - Carlos Fernandez
- Palm Beach Shoulder Service HCA FL - Atlantis Orthopaedics, 900 Village Square Crossing Suite 170, Palm Beach, FL, USA
- HCA JFK/University of Miami Miller School of Medicine Orthopaedic Surgery Residency Program, Palm Beach, FL, USA
| | - Alessia Lavin
- Palm Beach Shoulder Service HCA FL - Atlantis Orthopaedics, 900 Village Square Crossing Suite 170, Palm Beach, FL, USA
| | - Garrett R Jackson
- Palm Beach Shoulder Service HCA FL - Atlantis Orthopaedics, 900 Village Square Crossing Suite 170, Palm Beach, FL, USA
- HCA JFK/University of Miami Miller School of Medicine Orthopaedic Surgery Residency Program, Palm Beach, FL, USA
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12
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Preukschas AA, Wise PA, Bettscheider L, Pfeiffer M, Wagner M, Huber M, Golriz M, Fischer L, Mehrabi A, Rössler F, Speidel S, Hackert T, Müller-Stich BP, Nickel F, Kenngott HG. Comparing a virtual reality head-mounted display to on-screen three-dimensional visualization and two-dimensional computed tomography data for training in decision making in hepatic surgery: a randomized controlled study. Surg Endosc 2024; 38:2483-2496. [PMID: 38456945 PMCID: PMC11078809 DOI: 10.1007/s00464-023-10615-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 11/26/2023] [Indexed: 03/09/2024]
Abstract
OBJECTIVE Evaluation of the benefits of a virtual reality (VR) environment with a head-mounted display (HMD) for decision-making in liver surgery. BACKGROUND Training in liver surgery involves appraising radiologic images and considering the patient's clinical information. Accurate assessment of 2D-tomography images is complex and requires considerable experience, and often the images are divorced from the clinical information. We present a comprehensive and interactive tool for visualizing operation planning data in a VR environment using a head-mounted-display and compare it to 3D visualization and 2D-tomography. METHODS Ninety medical students were randomized into three groups (1:1:1 ratio). All participants analyzed three liver surgery patient cases with increasing difficulty. The cases were analyzed using 2D-tomography data (group "2D"), a 3D visualization on a 2D display (group "3D") or within a VR environment (group "VR"). The VR environment was displayed using the "Oculus Rift ™" HMD technology. Participants answered 11 questions on anatomy, tumor involvement and surgical decision-making and 18 evaluative questions (Likert scale). RESULTS Sum of correct answers were significantly higher in the 3D (7.1 ± 1.4, p < 0.001) and VR (7.1 ± 1.4, p < 0.001) groups than the 2D group (5.4 ± 1.4) while there was no difference between 3D and VR (p = 0.987). Times to answer in the 3D (6:44 ± 02:22 min, p < 0.001) and VR (6:24 ± 02:43 min, p < 0.001) groups were significantly faster than the 2D group (09:13 ± 03:10 min) while there was no difference between 3D and VR (p = 0.419). The VR environment was evaluated as most useful for identification of anatomic anomalies, risk and target structures and for the transfer of anatomical and pathological information to the intraoperative situation in the questionnaire. CONCLUSIONS A VR environment with 3D visualization using a HMD is useful as a surgical training tool to accurately and quickly determine liver anatomy and tumor involvement in surgery.
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Affiliation(s)
- Anas Amin Preukschas
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 672, 69120, Heidelberg, Germany
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Philipp Anthony Wise
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 672, 69120, Heidelberg, Germany
| | - Lisa Bettscheider
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 672, 69120, Heidelberg, Germany
| | - Micha Pfeiffer
- Institute for Anthropomatics and Robotics, Karlsruhe Institute of Technology, Kaiserstrasse 12, 76131, Karlsruhe, Germany
- Department for Translational Surgical Oncology, National Center for Tumor Diseases, Fiedlerstraße 23, 01307, Dresden, Germany
| | - Martin Wagner
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 672, 69120, Heidelberg, Germany
| | - Matthias Huber
- Institute for Anthropomatics and Robotics, Karlsruhe Institute of Technology, Kaiserstrasse 12, 76131, Karlsruhe, Germany
| | - Mohammad Golriz
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 672, 69120, Heidelberg, Germany
| | - Lars Fischer
- Department of Surgery, Hospital Mittelbaden, Balgerstrasse 50, 76532, Baden-Baden, Germany
| | - Arianeb Mehrabi
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 672, 69120, Heidelberg, Germany
| | - Fabian Rössler
- Department of Surgery and Transplantation, University Hospital of Zürich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Stefanie Speidel
- Department for Translational Surgical Oncology, National Center for Tumor Diseases, Fiedlerstraße 23, 01307, Dresden, Germany
| | - Thilo Hackert
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 672, 69120, Heidelberg, Germany
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Beat Peter Müller-Stich
- Division of Abdominal Surgery, Clarunis Academic Centre of Gastrointestinal Diseases, St. Clara and University Hospital of Basel, Petersgraben 4, 4051, Basel, Switzerland
| | - Felix Nickel
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 672, 69120, Heidelberg, Germany
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Hannes Götz Kenngott
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 672, 69120, Heidelberg, Germany.
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Rometsch C, Festl-Wietek T, Bäuerle A, Schweda A, Skoda EM, Schäffeler N, Stengel A, Zipfel S, Teufel M, Herrmann-Werner A. Anxiety and Somatoform Syndromes Predict Transplant-Focused Internet Use in the Course of an Organ Transplantation. Telemed J E Health 2024; 30:e1172-e1179. [PMID: 37902962 DOI: 10.1089/tmj.2023.0137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2023] Open
Abstract
Background: e-Health interventions are increasing in the field of organ transplantations; however, the literature lacks evidence regarding needs, attitudes, and preferences of organ recipients and donors during the course of an organ transplantation. Methods: In a cross-sectional study, 70 subjects were assessed using self-rated and validated questionnaires, such as the PRIME MD Patient Health Questionnaire (PHQ-D) and the Essen Resource Inventory (ERI). Group differences and a multiple linear regression were also applied. Results: Organ recipients had significantly higher scores for depression (U = 245.00, z = -2.65, p = 0.008, Cohen's d = 0.32), somatoform (U = 224.50, z = -2.99, p = 0.003, Cohen's d = 0.37), and stress syndromes (U = 266.00, z = -2.25, p = 0.008, Cohen's d = 0.27). They also named the internet and apps as resources to find information regarding organ transplants (U = 177.50, z = -2.07, p = 0.017, Cohen's d = 0.28; Z = -2.308, p = 0.021) and preferred to use apps to monitor the physical condition (Z = -2.12, p = 0.034) significantly more than organ donors. Anxiety and somatoform syndromes were significant predictors to search for information regarding the transplant process (F[6,38] = 3.98, p < 0.001; R2 = 0.386). Conclusions: e-Health interventions are promising in accompanying the course of an organ transplant for patients to be informed and educated. Predominantly, potential organ recipients might benefit from apps to record physical parameters. However, anxiety syndromes might hinder patients from searching for information about the transplant process, while somatoform syndromes might enable patients who are searching for such information.
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Affiliation(s)
- Caroline Rometsch
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
- Department of Experimental and Clinical Medicine, University of Florence, Firenze, Italy
| | - Teresa Festl-Wietek
- TIME-Tübingen Institute for Medical Education, Medical Faculty Tübingen, Tübingen, Germany
| | - Alexander Bäuerle
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- West German Center for Organ Transplantation, University Hospital Essen, Essen, Germany
| | - Adam Schweda
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- West German Center for Organ Transplantation, University Hospital Essen, Essen, Germany
| | - Eva Maria Skoda
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- West German Center for Organ Transplantation, University Hospital Essen, Essen, Germany
| | - Norbert Schäffeler
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Andreas Stengel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Martin Teufel
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- West German Center for Organ Transplantation, University Hospital Essen, Essen, Germany
| | - Anne Herrmann-Werner
- TIME-Tübingen Institute for Medical Education, Medical Faculty Tübingen, Tübingen, Germany
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Thawani SP, Minen MT, Grossman SN, Friedman S, Bhatt JM, Foo FYA, Torres DM, Weinberg HJ, Kim NH, Levitan V, Cardiel MI, Zakin E, Conway JM, Kurzweil AM, Hasanaj L, Stainman RS, Seixas A, Galetta SL, Balcer LJ, Busis NA. A Comparison of Patients' and Neurologists' Assessments of their Teleneurology Encounter: A Cross-Sectional Analysis. Telemed J E Health 2024; 30:841-849. [PMID: 37624656 DOI: 10.1089/tmj.2023.0168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023] Open
Abstract
Background and Objectives: To better understand patients' and neurologists' assessments of their experiences regarding effectiveness of teleneurology encounters. Methods: Following an audio-video telehealth visit, neurologists asked patients to participate in a survey-based research study about the encounter, and then, the neurologists also recorded their own evaluations. Data were analyzed using standard quantitative and qualitative techniques for dichotomous and ordered-category survey responses in this cross-sectional analysis. Results: The study included unique encounters between 187 patients and 11 general neurologists. The mean patient age was 49 ± 17.5 years. Two thirds of the patients (66.8%, 125/187) were female. One third (33.2%; 62) were patients new to the NYU Langone Health neurology practices. The most common patient chief complaints were headache (69/187, 36.9%), focal and generalized numbness or tingling (21, 11.2%), memory difficulty (15, 8%), spine-related symptoms (12, 6.4%), and vertigo (11, 5.9%). Most patients (94.7%, 177/187) reported that the teleneurology encounter satisfied their needs. Patients and their neurologists agreed that the experience was effective in 91% (162/178) of encounters, regardless of whether the visit was for a new or established patient visit. Discussion: More than 90% of new and established patients and their neurologists agreed that teleneurology encounters were effective despite some limitations of the examination, the occasional need for patient assistance, and technical difficulties. Our results provide further evidence to justify and to expand the clinical use of teleneurology.
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Affiliation(s)
- Sujata P Thawani
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
| | - Mia T Minen
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Scott N Grossman
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
| | - Steven Friedman
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Jaydeep M Bhatt
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
| | - Farng-Yang A Foo
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
| | - Daniel M Torres
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
| | - Harold J Weinberg
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
| | - Nina H Kim
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
| | - Valeriya Levitan
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
| | - Myrna I Cardiel
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
| | - Elina Zakin
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
| | - Jenna M Conway
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
| | - Arielle M Kurzweil
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
| | - Lisena Hasanaj
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
| | - Rebecca S Stainman
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
| | - Azizi Seixas
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
- Department of Informatics and Health Data Science, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Steven L Galetta
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
- Department of Ophthalmology, NYU Grossman School of Medicine, New York, New York, USA
| | - Laura J Balcer
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
- Department of Ophthalmology, NYU Grossman School of Medicine, New York, New York, USA
| | - Neil A Busis
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
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15
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Almizani MS, Alshahir AA, Alsaygh EF, Alotaibi KM, Alzuaki MA, Almuslami AY, Aldakhil LO, AlYousif HA. Adaption and Usability of Telemedicine in Orthopedic Surgery in Saudi Arabia: A Nationwide Cross-Sectional Study. Telemed J E Health 2024; 30:858-865. [PMID: 37751198 DOI: 10.1089/tmj.2023.0289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023] Open
Abstract
Background: Telemedicine has proven beneficial in improving patient satisfaction and access to care and reducing health care costs. The effectiveness of telemedicine in orthopedic surgery has been reported. However, data on its use in Saudi Arabia are scarce. This study aimed to assess the effectiveness of telemedicine in orthopedic surgery in Saudi Arabia to better understand its integration and efficiency in this field. Methods: This was a cross-sectional study conducted between August and December 2022 to evaluate the knowledge and practice of telemedicine among orthopedic board-certified physicians in Saudi Arabia. Data were collected using a valid, structured, self-administered questionnaire distributed online via Google Forms. Results: A total of 111 orthopedic surgeons were included in this study. Most of the participants were males (95.5%), consultants (39.6%), and working in the central region (55.8%). Approximately 44.1% of the physicians used telemedicine before the coronavirus disease 2019 pandemic, while 94% used it during the pandemic. More than half of the physicians reported easy access to telemedicine. However, most of the physicians reported that they were not satisfied with conducting virtual physical examinations for new, follow-up, and postoperative patients and were mostly satisfied with taking the virtual history. Conclusion: This study suggests that telemedicine is highly adopted for follow-up care and postoperative management in orthopedics, with high satisfaction rates among surgeons.
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Affiliation(s)
- Mohammed S Almizani
- Orthopedic Surgery Department, King Saudi Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Alwaleed Abdullah Alshahir
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Ehab Fayez Alsaygh
- College of Medicine, Taibah University, Almadinah Almunawwarah, Kingdom of Saudi Arabia
| | - Kholoud Mohsen Alotaibi
- College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Kingdom of Saudi Arabia
| | | | - Ali Yousef Almuslami
- Orthopedic Surgery Department, King Saudi Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Lina Othman Aldakhil
- Research & Innovation Centre, King Saudi Medical City, Riyadh, Kingdom of Saudi Arabia
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16
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Wang QP, Chang WY, Han MM, Hu YX, Lin SS, Gu YC. Application of telemedicine system for older adults postoperative patients in community: a feasibility study. Front Public Health 2024; 12:1291916. [PMID: 38435285 PMCID: PMC10904463 DOI: 10.3389/fpubh.2024.1291916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 02/06/2024] [Indexed: 03/05/2024] Open
Abstract
Purpose In response to the growing challenges posed by an aging society, a telemedicine system was developed specifically for older adults postoperative patients, and its effectiveness was thoroughly investigated. Methods Between May 2020 and May 2022, a total of 88 older adults postoperative patients were enrolled and randomly allocated into an experimental group and a control group. The experimental group received telemedicine services after discharge, while the control group received conventional medical services following the traditional protocol. One month after discharge, various indicators were evaluated for both groups, including number of visits, medical expenditures, postoperative recovery, anxiety, depression and satisfaction. Results The number of visits and medical expenditures of the experimental group were less than those of the control group [1 (0, 1) vs. 1 (1, 2), Z = -3.977, p < 0.001; 25.25 (0.00, 277.40) yuan vs. 174.65 (49.63, 446.10) yuan, Z = -2.150, p = 0.032]. In both groups, there were 2 cases of incision infection, respectively. No significant difference was observed between the two groups (Fisher χ2, p = 0.259). In both groups, there was no instance of incision bleeding, incision dehiscence, readmission, or reoperation. Additionally, there was no significant difference in physical status between the two groups at discharge and after discharge (66.06 ± 8.92 vs. 65.45 ± 7.39 t = 0.287, p = 0.775; 73.33 ± 9.97 vs. 70.91 ± 7.50, t = 1.202, p = 0.235). And there was no significant difference in the change of physical status between the two groups after discharge [10.00 (0.00, 10.00) vs. 5.00 (0.00, 10.00), Z = -1.077, p = 0.281]. There was no significant difference in body weight change between the two groups after discharge [1.05 (0.38, 1.60) Kg vs. 0.80 (0.50, 1.43) Kg, Z = -0.265, p = 0.791]. There was no significant difference in the levels of anxiety and depression between the two groups at discharge (45.64 ± 8.10 vs. 44.60 ± 8.24, t = 0.520, p = 0.604, 48.33 ± 8.46 vs. 47.50 ± 6.85, t = 0.418, p = 0.677). But the levels of anxiety and depression in the experimental group were lower than those in the control group after discharge (34.92 ± 7.38 vs. 39.03 ± 8.42, t = -2.183, p = 0.032, 37.86 ± 7.29 vs. 41.93 ± 7.13, t = -2.281, p = 0.025); The change of anxiety level and depression level of the experimental group were more than those of the control group [-10.00 (-11.25, -8.75) vs. -5.00 (-7.81, -3.75), Z = -5.277, p < 0.001; -10.00 (-12.50, -7.50) vs. -5.00 (-7.75, -3.44), Z = -4.596, p < 0.001]. The level of satisfaction regarding medical services, daily care, and psychological comfort was higher in the experimental group compared to the control group [3 (3, 3.25) vs. 2 (1, 2), Z = -5.931, p < 0.001; 3 (3, 4) vs. 3 (2, 3), Z = -2.286, p = 0.022; 2 (1, 3) vs. 1 (0.75, 2), Z = -2.081, p = 0.037]. Conclusion In the context of an aging society, telemedicine system can offer improved healthcare to older adults postoperative patients. This includes benefits such as reducing number of visits, saving medical expenditures, enhancing psychological comfort and daily care.
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Affiliation(s)
- Quan-Peng Wang
- General Surgery Department, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, Wenzhou, China
| | - Wan-Ying Chang
- Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Man-Man Han
- General Surgery Department, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, Wenzhou, China
| | - Ye-Xiao Hu
- General Surgery Department, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, Wenzhou, China
| | - Sai-Sai Lin
- General Surgery Department, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, Wenzhou, China
| | - Ye-Chun Gu
- General Surgery Department, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, Wenzhou, China
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Yankappa N, Kumar A, Prasad A, Tiwari L, Kumar P. Clinicodemographic Profile and Clinical Outcome of Children Presenting to Telemedicine Center at Institute of National Importance of India: A Prospective Observational Study. Int J Telemed Appl 2024; 2024:5341988. [PMID: 38327874 PMCID: PMC10849814 DOI: 10.1155/2024/5341988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 01/16/2024] [Accepted: 01/18/2024] [Indexed: 02/09/2024] Open
Abstract
Background There is a global shortage of healthcare professionals, especially in developing countries, leading to disparities in access to healthcare, worsened by the pandemic. Telemedicine is emerging as a solution, with growing adoption worldwide due to advancements in technology and increased awareness. Research Problem. The establishment of telemedicine depends on resources, infrastructure, and knowledge about healthcare needs. Further studies are needed to monitor and address evolving issues in telemedicine. The Overall Purpose of the Study. Rural health disparities stem from multiple factors, like limited healthcare access, workforce shortages, lifestyle choices, and lower socioeconomic status, leading to higher mortality and chronic diseases. Addressing these challenges is vital for rural community well-being. Telemedicine centers present a promising solution, bridging gaps, and improving healthcare outcomes for underserved remote populations. Methodology. Objective: This study assessed the clinicodemographic profile and clinical outcome of children presenting to the telemedicine center at the Institute of National Importance in India. Design: Prospective observational study. Setting: A single-center tertiary care level. Participants: This study included 79 children aged up to 18 years. Major Findings and Summary of Interpretations. In our study, 79 children using telemedicine found a near-equal gender distribution. 8.9% needed emergency care, with common complaints being respiratory issues, fever, abdominal pain, and vomiting. After two weeks, 83.5% showed improvement, emphasizing telemedicine's effectiveness in pediatric care. Conclusion Our study underscores telemedicine's positive impact on pediatric healthcare, emphasizing its potential to enhance access, outcomes, and cost-efficiency. Wider telemedicine adoption can reduce morbidity and mortality, support preventive care, and streamline posttreatment services, alleviating pressure on specialized facilities. While our focus was pediatrics, the telemedicine model is adaptable to various age groups and conditions, but it should be seen as a valuable supplement to, not a total substitute for, in-person healthcare visits.
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Affiliation(s)
- N. Yankappa
- Department of Paediatrics, All India Institute of Medical Sciences, Patna, India
| | - Anil Kumar
- Department of Trauma Surgery & Critical Care, All India Institute of Medical Sciences, Patna, India
| | - Arun Prasad
- Department of Paediatrics, All India Institute of Medical Sciences, Patna, India
| | - Lokesh Tiwari
- Department of Paediatrics, All India Institute of Medical Sciences, Patna, India
| | - Pradeep Kumar
- Department of Paediatrics, All India Institute of Medical Sciences, Patna, India
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Khan N, Pitchforth E, Winder R, Abel G, Clark CE, Cockcroft E, Campbell J. What helps patients access web-based services in primary care? Free-text analysis of patient responses to the Di-Facto questionnaire. BMC PRIMARY CARE 2024; 25:20. [PMID: 38200431 PMCID: PMC10777578 DOI: 10.1186/s12875-023-02257-5] [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: 05/30/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND The National Health Service (NHS) and general practice are increasingly adopting digital services. These services can impact both positively and negatively upon patient experiences, and access to digital services is not equal amongst all groups. Within a wider project examining digital facilitation (the Di-Facto study) our team conducted a patient survey amongst English primary care practices aiming to investigate patient views of what supports uptake and use of web-based services. This paper reports on the analysis of the free-text responses from the patient survey. METHODS The Di-Facto patient survey was distributed to practices in eight clinical commissioning groups (CCGs) in England between 2021-2022. We examined free-text responses to two questions relating to access to primary care web-based and support for web-based services. We used qualitative reflexive thematic analysis based on a six-stage process to analyse responses. RESULTS Of the 3051 patients who responded to the Di-Facto survey, 2246 provided a free-text response. We present our findings in two major themes: systems and structures and their impact on use of web-based services, and 'what works for me', a description of how respondents described what worked, or did not work in terms of their interactions with web-based services. Respondents described how the technology, such as poor practice website design, confusion over multiple digital apps, data security and concerns about eConsultation offerings impacted on use of web-based services. Respondents described practice level barriers, such as a lack of or inconsistent provision, which prevented optimal use of web-based services. Respondents described personal and technical barriers that impacted on their use of digital services, and described which web-based services worked well for them. Respondents felt that web-based services were not a replacement for face-to-face interactions with a doctor. CONCLUSIONS This analysis of free-text responses from a large patient survey highlights the system, practice, and person level barriers and facilitators to use of digital services in primary care. With an increasing push towards digital solutions in NHS primary care, practices should consider the design, rollout and communication of their web-based services to support patient access.
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Affiliation(s)
- Nada Khan
- Exeter Collaboration for Academic Primary Care, College of Medicine and Health, University of Exeter, Exeter, UK.
| | - Emma Pitchforth
- Exeter Collaboration for Academic Primary Care, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Rachel Winder
- Exeter Collaboration for Academic Primary Care, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Gary Abel
- Exeter Collaboration for Academic Primary Care, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Christopher E Clark
- Exeter Collaboration for Academic Primary Care, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Emma Cockcroft
- Exeter Collaboration for Academic Primary Care, College of Medicine and Health, University of Exeter, Exeter, UK
| | - John Campbell
- Exeter Collaboration for Academic Primary Care, College of Medicine and Health, University of Exeter, Exeter, UK
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Schröder H, Beckers SK, Borgs C, Sommer A, Rossaint R, Grüßer L, Felzen M. Long-term effects of a prehospital telemedicine system on structural and process quality indicators of an emergency medical service. Sci Rep 2024; 14:310. [PMID: 38172217 PMCID: PMC10764932 DOI: 10.1038/s41598-023-50924-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 12/28/2023] [Indexed: 01/05/2024] Open
Abstract
The benefits of a telemedical support system for prehospital emergency medical services include high-level emergency medical support at the push of a button: delegation of drug administration, diagnostic assistance, initiation of therapeutic measures, or choice of hospital destination. At various European EMS sites telemedical routine systems are shortly before implementation. The aim of this study was to investigate the long-term effects of implementing a tele-EMS system on the structural and procedural quality indicators and therefore performance of an entire EMS system. This retrospective study included all EMS missions in Aachen city between 2015 and 2021. Regarding structural indicators of the EMS system, we investigated the overall number of emergency missions with tele-EMS and onsite EMS physicians. Furthermore, we analyzed the distribution of tracer diagnosis and process quality with respect to the time spans on the scene, time until teleconsultation, duration of teleconsultation, prehospital engagement time, and number of simultaneous teleconsultations. During the 7-year study period, 229,384 EMS missions were completed. From 2015 to 2021, the total number of EMS missions increased by 8.5%. A tele-EMS physician was consulted on 23,172 (10.1%) missions. The proportion of telemedicine missions increased from 8.6% in 2015 to 12.9% in 2021. Teleconsultations for missions with tracer diagnoses decreased during from 43.7% to 30.7%, and the proportion of non-tracer diagnoses increased from 56.3% to 69.3%. The call duration for teleconsultation decreased from 12.07 min in 2015 to 9.42 min in 2021. For every fourth mission, one or more simultaneous teleconsultations were conducted by the tele-EMS physician on duty. The implementation and routine use of a tele-EMS system increased the availability of onsite EMS physicians and enabled immediate onsite support for paramedics. Parallel teleconsultations, reduction in call duration, and increase in ambulatory onsite treatments over the years demonstrate the increasing experience of paramedics and tele-EMS physicians with the system in place. A prehospital tele-EMS system is important for mitigating the current challenges in the prehospital emergency care sector.
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Affiliation(s)
- Hanna Schröder
- Department of Anesthesiology, Medical Faculty RWTH Aachen University, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany.
- Aachen Institute for Rescue Management and Public Safety, City of Aachen and University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany.
| | - Stefan K Beckers
- Department of Anesthesiology, Medical Faculty RWTH Aachen University, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
- Aachen Institute for Rescue Management and Public Safety, City of Aachen and University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
- Medical Direction of Aachen Fire Department, Stolberger Strasse 155, 52068, Aachen, Germany
| | - Christina Borgs
- Department of Anesthesiology, Medical Faculty RWTH Aachen University, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
- Aachen Institute for Rescue Management and Public Safety, City of Aachen and University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Anja Sommer
- Department of Anesthesiology, Medical Faculty RWTH Aachen University, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
- Aachen Institute for Rescue Management and Public Safety, City of Aachen and University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Rolf Rossaint
- Department of Anesthesiology, Medical Faculty RWTH Aachen University, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Linda Grüßer
- Department of Anesthesiology, Medical Faculty RWTH Aachen University, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Marc Felzen
- Department of Anesthesiology, Medical Faculty RWTH Aachen University, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
- Aachen Institute for Rescue Management and Public Safety, City of Aachen and University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
- Medical Direction of Aachen Fire Department, Stolberger Strasse 155, 52068, Aachen, Germany
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20
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Rossetto F, Mestanza Mattos FG, Gervasoni E, Germanotta M, Pavan A, Cattaneo D, Aprile I, Baglio F. Efficacy of telerehabilitation with digital and robotic tools for the continuity of care of people with chronic neurological disorders: The TELENEURO@REHAB protocol for a randomized controlled trial. Digit Health 2024; 10:20552076241228928. [PMID: 38465294 PMCID: PMC10924562 DOI: 10.1177/20552076241228928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 01/09/2024] [Indexed: 03/12/2024] Open
Abstract
Context Chronic Neurological Disorders (CNDs) are among the leading causes of disability worldwide, and their contribution to the overall need for rehabilitation is increasing. Therefore, the identification of new digital solutions to ensure early and continuous care is mandatory. Objective This protocol proposes to test the usability, acceptability, safety, and efficacy of Telerehabilitation (TR) protocols with digital and robotic tools in reducing the perceived level of disability in CNDs including Parkinson's Disease (PD), Multiple Sclerosis (MS), and post-stroke patients. Design Setting and Subjects This single-blinded, multi-site, randomized, two-treatment arms controlled clinical trial will involve PD (N = 30), MS (N = 30), and post-stroke (N = 30). Each participant will be randomized (1:1) to the experimental group (20 sessions of motor telerehabilitation with digital and robotic tools) or the active control group (20 home-based motor rehabilitation sessions according to the usual care treatment). Primary and secondary outcome measures will be obtained at the baseline (T0), post-intervention (T1, 5 weeks after baseline), and at follow-up (T2, 2 months after treatment). Main Outcome Measures a multifaceted evaluation including quality of life, motor, and clinical/functional measures will be conducted at each time-point of assessment. The primary outcome measures will be the change in the perceived level of disability as measured by the World Health Organization Disability Assessment Schedule 2.0. Conclusion The implementation of TR protocols will enable a more targeted and effective response to the growing need for rehabilitation linked to CNDs, ensuring accessibility to rehabilitation services from the initial stages of the disease.
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Affiliation(s)
| | | | - Elisa Gervasoni
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan-Florence, Italy
| | | | - Arianna Pavan
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan-Florence, Italy
| | - Davide Cattaneo
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan-Florence, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Irene Aprile
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan-Florence, Italy
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21
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Parameswaran V, Koos H, Kalwani N, Qureshi L, Rosengaus L, Dash R, Scheinker D, Rodriguez F, Johnson CB, Stange K, Aron D, Lyytinen K, Sharp C. Drivers of telemedicine in primary care clinics at a large academic medical centre. J Telemed Telecare 2023:1357633X231219311. [PMID: 38130140 DOI: 10.1177/1357633x231219311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
BACKGROUND COVID-19 disrupted healthcare routines and prompted rapid telemedicine implementation. We investigated the drivers of visit modality selection (telemedicine versus in-person) in primary care clinics at an academic medical centre. METHODS We used electronic medical record data from March 2020 to May 2022 from 13 primary care clinics (N = 21,031 new, N = 207,292 return visits), with 55% overall telemedicine use. Hierarchical logistic regression and cross-validation methods were used to estimate the variation in visit modality explained by the patient, clinician and visit factors as measured by the mean-test area under the curve (AUC). RESULTS There was significant variation in telemedicine use across clinicians (ranging from 0-100%) for the same visit diagnosis. The strongest predictors of telemedicine were the clinician seen for new visits (mean AUC of 0.79) and the primary visit diagnosis for return visits (0.77). Models based on all patient characteristics combined accounted for relatively little variation in modality selection, 0.54 for new and 0.58 for return visits, respectively. Amongst patient characteristics, males, patients over 65 years, Asians and patient's with non-English language preferences used less telemedicine; however, those using interpreter services used significantly more telemedicine. CONCLUSION Clinician seen and primary visit diagnoses were the best predictors of visit modality. The distinction between new and return visits and the minimal impact of patient characteristics on visit modality highlights the complexity of clinical care and warrants research approaches that go beyond linear models to uncover the emergent causal effects of specific technology features mediated by tasks, people and organisations.
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Affiliation(s)
- Vijaya Parameswaran
- Division of Cardiovascular Medicine and the Cardiovascular Institute, Stanford University, Stanford, CA, USA
- Digital Health Care Integration, Stanford Health Care, Stanford, CA, USA
| | - Harrison Koos
- Department of Management Science & Engineering, Stanford University, Stanford, CA, USA
| | - Neil Kalwani
- Division of Cardiovascular Medicine and the Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Lubna Qureshi
- Digital Health Care Integration, Stanford Health Care, Stanford, CA, USA
| | - Leah Rosengaus
- Digital Health Care Integration, Stanford Health Care, Stanford, CA, USA
| | - Rajesh Dash
- Division of Cardiovascular Medicine and the Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - David Scheinker
- Division of Cardiovascular Medicine and the Cardiovascular Institute, Stanford University, Stanford, CA, USA
- Department of Management Science & Engineering, Stanford University, Stanford, CA, USA
| | - Fatima Rodriguez
- Division of Cardiovascular Medicine and the Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Cati-Brown Johnson
- Stanford University School of Medicine, Evaluation Sciences Unit, Division of Primary Care and Population Health, Stanford, CA, USA
| | - Kurt Stange
- Center for Community Health Integration, Case Western Reserve University, Cleveland, OH, USA
| | - David Aron
- Weatherhead School of Management, Case Western Reserve University, Cleveland, OH, USA
| | - Kalle Lyytinen
- Weatherhead School of Management, Case Western Reserve University, Cleveland, OH, USA
| | - Christopher Sharp
- Digital Health Care Integration, Stanford Health Care, Stanford, CA, USA
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22
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Wise PA, Studier-Fischer A, Nickel F, Hackert T. [Status Quo of Surgical Navigation]. Zentralbl Chir 2023. [PMID: 38056501 DOI: 10.1055/a-2211-4898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
Surgical navigation, also referred to as computer-assisted or image-guided surgery, is a technique that employs a variety of methods - such as 3D imaging, tracking systems, specialised software, and robotics to support surgeons during surgical interventions. These emerging technologies aim not only to enhance the accuracy and precision of surgical procedures, but also to enable less invasive approaches, with the objective of reducing complications and improving operative outcomes for patients. By harnessing the integration of emerging digital technologies, surgical navigation holds the promise of assisting complex procedures across various medical disciplines. In recent years, the field of surgical navigation has witnessed significant advances. Abdominal surgical navigation, particularly endoscopy, laparoscopic, and robot-assisted surgery, is currently undergoing a phase of rapid evolution. Emphases include image-guided navigation, instrument tracking, and the potential integration of augmented and mixed reality (AR, MR). This article will comprehensively delve into the latest developments in surgical navigation, spanning state-of-the-art intraoperative technologies like hyperspectral and fluorescent imaging, to the integration of preoperative radiological imaging within the intraoperative setting.
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Affiliation(s)
- Philipp Anthony Wise
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Alexander Studier-Fischer
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Felix Nickel
- Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Thilo Hackert
- Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
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23
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Rossetto F, Isernia S, Realdon O, Borgnis F, Blasi V, Pagliari C, Cabinio M, Alberoni M, Mantovani F, Clerici M, Baglio F. A digital health home intervention for people within the Alzheimer's disease continuum: results from the Ability-TelerehABILITation pilot randomized controlled trial. Ann Med 2023; 55:1080-1091. [PMID: 36929703 PMCID: PMC10030155 DOI: 10.1080/07853890.2023.2185672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
PURPOSE This study tested the efficacy of digital-health home intervention for people within the Alzheimer's disease (AD)-continuum. METHODS Thirty people within the AD continuum were randomly assigned to a telerehabilitation (ABILITY; 6 males, Mage=78.2 ± 3.95) or treatment as usual (TAU; 8 males, Mage=77.13 ± 6.38), performing cognitive and physical activities at home for six weeks. The ABILITY intervention additionally included a digital platform enabling communication between the hospital and the patient's home. Efficiency, such as adherence, perceived fit of demands and skills, usability, and effectiveness measures, including neuropsychological level, neuropsychiatric symptoms, and autonomy in daily living, were collected before (T0), after the treatment (T1), and at the 1-year-follow-up (T2). RESULTS The ABILITY program was efficient, with a higher adherence (81% vs. 62%), a higher perceived fit of demands and skills than TAU (p<.05), and a good level of technology usability. In terms of effectiveness, a treatment effect (ABILITY > TAU) emerged on the global cognitive level, especially in language, executive functions, and memory domains. Moreover, a treatment carry-over effect (1-year follow-up) was observed in global cognitive functions (especially language) (ABILITY > TAU), behavioral symptoms, and caregiver distress (TAU > ABILITY). CONCLUSIONS Our preliminary findings suggest that ABILITY is a promising eHealth intervention to improve at-home treatment adherence and to preserve cognitive and behavioral abilities.
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Affiliation(s)
| | - Sara Isernia
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Olivia Realdon
- Department of Human Sciences for Education, Università degli Studi di Milano-Bicocca, Milan, Italy
| | | | - Valeria Blasi
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | | | - Monia Cabinio
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | | | - Fabrizia Mantovani
- Department of Human Sciences for Education, Università degli Studi di Milano-Bicocca, Milan, Italy
| | - Mario Clerici
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
- Department of Physiopathology and Transplants, Università degli Studi di Milano, Milan, Italy
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24
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Parameshwarappa PM, Olickal JJ. Telemedicine Awareness and the Preferred Digital Healthcare Tools: A Community-based Cross-sectional Study from Rural Karnataka, India. Indian J Community Med 2023; 48:915-919. [PMID: 38249713 PMCID: PMC10795884 DOI: 10.4103/ijcm.ijcm_770_22] [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: 09/12/2022] [Accepted: 10/17/2023] [Indexed: 01/23/2024] Open
Abstract
Background The Indian government launched national teleconsultation services (eSanjeevani OPD) to provide safe doctor-to-patient consultations. This study aimed to determine the awareness and willingness to seek services from eSanjeevani OPDs. Material and Methods This is a cross-sectional descriptive study conducted in Nandigudi village, Karnataka. The total sample size was 273, and participants were recruited using a systematic sampling technique. Results The prevalence of awareness about teleconsultations was 2.2% (n = 6, 95% CI: 0.8-4.7%). None of the participants utilized eSanjeevani services in the last year. Approximately 56.0% (n = 153, 95% CI: 49.9-62.0%) were willing to use eSanjeevani OPD. "Not being familiar" (n = 99, 82.5%) with eSanjeevani OPD was the major reason for unwillingness to use teleconsultation, and 73.8% (n = 113) preferred video calls as the mode of communication. Conclusion The majority of the participants were not aware of and were unwilling to use eSanjeevani OPD. Therefore, healthcare professionals should focus more on creating awareness of teleconsultations.
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Affiliation(s)
| | - Jeby Jose Olickal
- Department of Public Health, Amrita Institute of Medical Sciences, Kochi, Kerala, India
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25
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Qi X, Ng WWH, Tsang GHK, To CKS. Efficacy of a Self-Directed Video-Based Caregiver-Implemented Language Programme. Folia Phoniatr Logop 2023; 76:245-263. [PMID: 37883946 DOI: 10.1159/000534022] [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: 03/14/2023] [Accepted: 09/01/2023] [Indexed: 10/28/2023] Open
Abstract
INTRODUCTION Caregiver-implemented language programmes are effective for alleviating early language difficulties. This study examined the efficacy of a self-directed video-based caregiver-implement language programme in Chinese families. METHOD This study consisted of two stages. In stage 1, 31 caregiver-child dyads (typically developing children) completed the training programme (group 1) in the form of six video-based training modules. In stage 2, 28 caregiver-child dyads (children with language difficulties) receiving active speech therapy were randomly assigned to the training (group 2) and control arms (group 3). Group 2 received the same training as group 1 in addition to their regular therapy while group 3 was kept as status quo. Caregivers completed a quiz on their knowledge of language facilitation techniques (LFTs) and submitted caregiver-child interaction videos at the start and end of the training. Outcome measures included programme completion rate, quiz scores, and use of LFTs and children's communication skills in the videos. A pre-post design and a between-group design were adopted in the stage 1 and 2 studies, respectively. RESULTS A completion rate of about 60% in both stages was noted. Significantly higher post-training knowledge scores were found in groups 1 and 2. General but nonsignificant growth in use of parallel talk and gesture, and significant gains in children's vocalization in the training arm were observed. CONCLUSION The self-directed video-based training programme would be useful in imparting information to caregivers. However, the modest improvements in the use of LFTs suggested direct coaching appeared to still play a significant role in enhancing the actual implementation of LFTs. Further investigation on a larger scale is required to evaluate the effectiveness of the training programme for promoting the wider use of this mode as a preventive measure.
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Affiliation(s)
- Xin Qi
- Academic Unit of Human Communication, Development and Information Sciences, Faculty of Education, The University of Hong Kong, Hong Kong, Hong Kong, China
| | - Winnie W H Ng
- Academic Unit of Human Communication, Development and Information Sciences, Faculty of Education, The University of Hong Kong, Hong Kong, Hong Kong, China
| | - Gigi H K Tsang
- Academic Unit of Human Communication, Development and Information Sciences, Faculty of Education, The University of Hong Kong, Hong Kong, Hong Kong, China
| | - Carol K S To
- Academic Unit of Human Communication, Development and Information Sciences, Faculty of Education, The University of Hong Kong, Hong Kong, Hong Kong, China
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26
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Li Y, Chen K, Pang Y, Zhang J, Wu M, Xu Y, Cao S, Zhang X, Wang S, Sun Y, Ning X, Wang X, Kong D. Multifunctional Microneedle Patches via Direct Ink Drawing of Nanocomposite Inks for Personalized Transdermal Drug Delivery. ACS NANO 2023; 17:19925-19937. [PMID: 37805947 DOI: 10.1021/acsnano.3c04758] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Additive manufacturing, commonly known as 3D printing, allows decentralized drug fabrication of orally administered tablets. Microneedles are comparatively favorable for self-administered transdermal drug delivery with improved absorption and bioavailability. Due to the cross-scale geometric characteristics, 3D-printed microneedles face a significant trade-off between the feature resolution and production speed in conventional layer-wise deposition sequences. In this study, we introduce an economical and scalable direct ink drawing strategy to create drug-loaded microneedles. A freestanding microneedle is efficiently generated upon each pneumatic extrusion and controlled drawing process. Sharp tips of ∼5 μm are formed with submillimeter nozzles, representing 2 orders of magnitude improved resolution. As the key enabler of this fabrication strategy, the yield-stress fluid inks are formulated by simply filling silica nanoparticles into regular polymer solutions. The approach is compatible with various microneedles based on dissolvable, biodegradable, and nondegradable polymers. Various matrices are readily adopted to adjust the release behaviors of the drug-loaded microneedles. Successful fabrication of multifunctional patches with heterogeneously integrated microneedles allows the treatment of melanoma via synergistic photothermal therapy and combination chemotherapy. The personalized patches are designed for cancer severity to achieve high therapeutic efficacy with minimal side effects. The direct ink drawing reported here provides a facile and low-cost fabrication strategy for multifunctional microneedle patches for self-administering transdermal drug delivery.
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Affiliation(s)
- Yanyan Li
- College of Engineering and Applied Sciences, Jiangsu Key Laboratory of Artificial Functional Materials, Nanjing University, Nanjing 210046, China
- State Key Laboratory of Analytical Chemistry for Life Science, Nanjing University, Nanjing 210046, China
| | - Kerong Chen
- College of Engineering and Applied Sciences, Jiangsu Key Laboratory of Artificial Functional Materials, Nanjing University, Nanjing 210046, China
- National Laboratory of Solid State Microstructure, Collaborative Innovation Center of Advanced Microstructures, Nanjing University, Nanjing 210093, China
- Chemistry and Biomedicine Innovation Center, Nanjing University, Nanjing 210046, China
| | - Yushuang Pang
- College of Engineering and Applied Sciences, Jiangsu Key Laboratory of Artificial Functional Materials, Nanjing University, Nanjing 210046, China
- State Key Laboratory of Analytical Chemistry for Life Science, Nanjing University, Nanjing 210046, China
| | - Jiaxue Zhang
- College of Engineering and Applied Sciences, Jiangsu Key Laboratory of Artificial Functional Materials, Nanjing University, Nanjing 210046, China
- State Key Laboratory of Analytical Chemistry for Life Science, Nanjing University, Nanjing 210046, China
| | - Ming Wu
- Key Laboratory of High Performance Polymer Materials and Technology of Ministry of Education, Department of Polymer Science and Engineering, School of Chemistry and Chemical Engineering, Nanjing University, Nanjing 210046, China
| | - Yurui Xu
- College of Engineering and Applied Sciences, Jiangsu Key Laboratory of Artificial Functional Materials, Nanjing University, Nanjing 210046, China
- National Laboratory of Solid State Microstructure, Collaborative Innovation Center of Advanced Microstructures, Nanjing University, Nanjing 210093, China
- Chemistry and Biomedicine Innovation Center, Nanjing University, Nanjing 210046, China
| | - Shitai Cao
- College of Engineering and Applied Sciences, Jiangsu Key Laboratory of Artificial Functional Materials, Nanjing University, Nanjing 210046, China
- State Key Laboratory of Analytical Chemistry for Life Science, Nanjing University, Nanjing 210046, China
| | - Xinxin Zhang
- College of Mechanical and Electronic Engineering, Shandong University of Science and Technology, Qingdao 266590, China
| | - Shaolei Wang
- College of Engineering and Applied Sciences, Jiangsu Key Laboratory of Artificial Functional Materials, Nanjing University, Nanjing 210046, China
- State Key Laboratory of Analytical Chemistry for Life Science, Nanjing University, Nanjing 210046, China
| | - Yuping Sun
- College of Engineering and Applied Sciences, Jiangsu Key Laboratory of Artificial Functional Materials, Nanjing University, Nanjing 210046, China
- State Key Laboratory of Analytical Chemistry for Life Science, Nanjing University, Nanjing 210046, China
| | - Xinghai Ning
- College of Engineering and Applied Sciences, Jiangsu Key Laboratory of Artificial Functional Materials, Nanjing University, Nanjing 210046, China
- National Laboratory of Solid State Microstructure, Collaborative Innovation Center of Advanced Microstructures, Nanjing University, Nanjing 210093, China
- Chemistry and Biomedicine Innovation Center, Nanjing University, Nanjing 210046, China
| | - Xiaoliang Wang
- Key Laboratory of High Performance Polymer Materials and Technology of Ministry of Education, Department of Polymer Science and Engineering, School of Chemistry and Chemical Engineering, Nanjing University, Nanjing 210046, China
| | - Desheng Kong
- College of Engineering and Applied Sciences, Jiangsu Key Laboratory of Artificial Functional Materials, Nanjing University, Nanjing 210046, China
- State Key Laboratory of Analytical Chemistry for Life Science, Nanjing University, Nanjing 210046, China
- National Laboratory of Solid State Microstructure, Collaborative Innovation Center of Advanced Microstructures, Nanjing University, Nanjing 210093, China
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Dillon J, Wick JY. Telehealth: Moving Older People Along the Adoption Trajectory. Sr Care Pharm 2023; 38:416-422. [PMID: 37771053 DOI: 10.4140/tcp.n.2023.415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
Although the concept of telehealth has been in development for many years, the global pandemic galvanized its growth and utility. In general, people adopt technological advancements at different velocities that, when plotted in a chart, resemble a bell-shaped curve. People who are quick to adopt new technologies are designated innovators, while those who are the very last to adopt new technologies are dubbed laggards. Often, older people fall into the laggard category for several reasons including physical, mental, and emotional barriers. In some cases, they lack the technology or experience with various programs that would make such programs accessible. Regardless, telehealth has proven its worth as a way to deliver care in areas distant to the health care provider when physical examination is unnecessary. It can reduce the likelihood of exposure to contagious disease. Telehealth also has the potential to reduce unnecessary emergency department visits, and long-term care facilities that have used telehealth have demonstrated cost savings. Little study has been conducted to determine how pharmacists are using telehealth, but after examining available research on telehealth, pharmacists can identify pitfalls and implement steps that reduce barriers for older people.
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Affiliation(s)
- Jessica Dillon
- University of Connecticut, School of Pharmacy, Storrs, Connecticut
| | - Jeannette Y Wick
- University of Connecticut, School of Pharmacy, Storrs, Connecticut
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28
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Xu D, Huang Y, Tsuei S, Fu H, Yip W. Factors influencing engagement in online dual practice by public hospital doctors in three large cities: A mixed-methods study in China. J Glob Health 2023; 13:04103. [PMID: 37736850 PMCID: PMC10514738 DOI: 10.7189/jogh.13.04103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023] Open
Abstract
Background In the digital age, a rising number of public sector doctors are providing private telemedicine and telehealth services on online health care platforms. This novel practice pattern - termed online dual practice - may profoundly impact health system performance in both developed and developing countries. This study aims to understand the factors influencing doctors' engagement in online dual practice. Methods Using a mixed-methods design, this study concurrently collects quantitative demographic and practice data (n = 71 944) and semi-structured interview data (n = 32) on secondary and tertiary public hospital doctors in three large Chinese cities: Beijing, Shanghai and Guangzhou. We use the quantitative data to examine the prevalence of the online dual practice and its associated factors via the binary logit regression model. The qualitative data are used to further explore associated factors of online dual practice via thematic analysis. The findings about associated factors from the two parts were merged using the categories of personal, professional, and organisational characteristics. Results Our quantitative analysis shows that at least 47.1% of public hospital doctors are involved in online dual practice. The shares in Beijing, Shanghai, and Guangzhou are 43.7%, 53.1%, and 44.8%, respectively. This practice is more prevalent among doctors who are male, senior, and non-managerial. Different specialties, hospital ownership, hospital levels, and locations are also significantly associated with this practice. The qualitative analysis further suggests that financial returns, perceived effectiveness of telemedicine, and hospital directors' attitude towards telemedicine may affect doctors' engagement with online dual practice. Conclusions Online dual practice is prevalent among doctors at tertiary and secondary public hospitals in Beijing, Shanghai, and Guangzhou. Personal, professional, and organisational characteristics are all associated with doctors' choice to engage in online dual practice. The findings in this study provide implications for promoting telemedicine adoption and developing relevant regulatory policies in China and other countries.
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Affiliation(s)
- Duo Xu
- Institute of Population and Labor Economics, Chinese Academy of Social Sciences, Beijing, China
| | - Yushu Huang
- Department of Health Policy and Management, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Sian Tsuei
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hongqiao Fu
- Department of Health Policy and Management, School of Public Health, Peking University Health Science Center, Beijing, China
- Center for Health Policy and Technology Evaluation, National Institute of Health Data Science at Peking University, Beijing, China
| | - Winnie Yip
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Pedro AR, Dias MB, Laranjo L, Cunha AS, Cordeiro JV. Artificial intelligence in medicine: A comprehensive survey of medical doctor's perspectives in Portugal. PLoS One 2023; 18:e0290613. [PMID: 37676884 PMCID: PMC10484446 DOI: 10.1371/journal.pone.0290613] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 08/12/2023] [Indexed: 09/09/2023] Open
Abstract
Artificial Intelligence (AI) is increasingly influential across various sectors, including healthcare, with the potential to revolutionize clinical practice. However, risks associated with AI adoption in medicine have also been identified. Despite the general understanding that AI will impact healthcare, studies that assess the perceptions of medical doctors about AI use in medicine are still scarce. We set out to survey the medical doctors licensed to practice medicine in Portugal about the impact, advantages, and disadvantages of AI adoption in clinical practice. We designed an observational, descriptive, cross-sectional study with a quantitative approach and developed an online survey which addressed the following aspects: impact on healthcare quality of the extraction and processing of health data via AI; delegation of clinical procedures on AI tools; perception of the impact of AI in clinical practice; perceived advantages of using AI in clinical practice; perceived disadvantages of using AI in clinical practice and predisposition to adopt AI in professional activity. Our sample was also subject to demographic, professional and digital use and proficiency characterization. We obtained 1013 valid, fully answered questionnaires (sample representativeness of 99%, confidence level (p< 0.01), for the total universe of medical doctors licensed to practice in Portugal). Our results reveal that, in general terms, the medical community surveyed is optimistic about AI use in medicine and are predisposed to adopt it while still aware of some disadvantages and challenges to AI use in healthcare. Most medical doctors surveyed are also convinced that AI should be part of medical formation. These findings contribute to facilitating the professional integration of AI in medical practice in Portugal, aiding the seamless integration of AI into clinical workflows by leveraging its perceived strengths according to healthcare professionals. This study identifies challenges such as gaps in medical curricula, which hinder the adoption of AI applications due to inadequate digital health training. Due to high professional integration in the healthcare sector, particularly within the European Union, our results are also relevant for other jurisdictions and across diverse healthcare systems.
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Affiliation(s)
- Ana Rita Pedro
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
| | - Michelle B. Dias
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Liliana Laranjo
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Ana Soraia Cunha
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - João V. Cordeiro
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
- CICS.NOVA Interdisciplinary Center of Social Sciences, Universidade NOVA de Lisboa, Lisbon, Portugal
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Khokhlova L, Komaris DS, Davarinos N, Mahalingam K, O'Flynn B, Tedesco S. Non-Invasive Assessment of Cartilage Damage of the Human Knee Using Acoustic Emission Monitoring: A Pilot Cadaver Study. IEEE Trans Biomed Eng 2023; 70:2741-2751. [PMID: 37027280 DOI: 10.1109/tbme.2023.3263388] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
OBJECTIVE Knee osteoarthritis is currently one of the top causes of disability in older population, a rate that will only increase in the future due to an aging population and the prevalence of obesity. However, objective assessment of treatment outcomes and remote evaluation are still in need of further development. Acoustic emission (AE) monitoring in knee diagnostics has been successfully adopted in the past; however, a wide discrepancy among the adopted AE techniques and analyses exists. This pilot study determined the most suitable metrics to differentiate progressive cartilage damage and the optimal frequency range and placement of AE sensors. METHODS Knee AEs were recorded in the 100-450 kHz and 15-200kH frequency ranges from a cadaver specimen in knee flexion/extension. Four stages of artificially inflicted cartilage damage and two sensor positions were investigated. RESULTS AE events in the lower frequency range and the following parameters provided better distinction between intact and damaged knee: hit amplitude, signal strength, and absolute energy. The medial condyle area of the knee was less prone to artefacts and unsystematic noise. Multiple reopenings of the knee compartment in the process of introducing the damage negatively affected the quality of the measurements. CONCLUSION Results may improve AE recording techniques in future cadaveric and clinical studies. SIGNIFICANCE This was the first study to evaluate progressive cartilage damage using AEs in a cadaver specimen. The findings of this study encourage further investigation of joint AE monitoring techniques.
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Zotey V, Andhale A, Shegekar T, Juganavar A. Adaptive Neuroplasticity in Brain Injury Recovery: Strategies and Insights. Cureus 2023; 15:e45873. [PMID: 37885532 PMCID: PMC10598326 DOI: 10.7759/cureus.45873] [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: 09/07/2023] [Accepted: 09/24/2023] [Indexed: 10/28/2023] Open
Abstract
This review addresses the relationship between neuroplasticity and recovery from brain damage. Neuroplasticity's ability to adapt becomes crucial since brain injuries frequently result in severe impairments. We begin by describing the fundamentals of neuroplasticity and how it relates to rehabilitation. Examining different forms of brain injuries and their neurological effects highlights the complex difficulties in rehabilitation. By revealing cellular processes, we shed light on synaptic adaptability following damage. Our study of synaptic plasticity digs into axonal sprouting, dendritic remodeling, and the balance of long-term potentiation. These processes depict neural resilience amid change. Then, after damage, we investigate immediate and slow neuroplastic alterations, separating reorganizations that are adaptive from those that are maladaptive. As we go on to rehabilitation, we evaluate techniques that use neuroplasticity's potential. These methods take advantage of the brain's plasticity for healing, from virtual reality and brain-computer interfaces to constraint-induced movement therapy. Ethics and individualized neurorehabilitation are explored. We scrutinize the promise of combination therapy and the difficulties in putting new knowledge into clinical practice. In conclusion, this analysis highlights neuroplasticity's critical role in brain injury recovery, providing sophisticated approaches to improve life after damage.
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Affiliation(s)
- Vaishnavi Zotey
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Amol Andhale
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Tejas Shegekar
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Anup Juganavar
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Button D, Levander XA, Cook RR, Miller WC, Salisbury-Afshar EM, Tsui JI, Ibragimov U, Jenkins WD, Westergaard RP, Korthuis PT. Substance use disorder treatment and technology access among people who use drugs in rural areas of the United States: A cross-sectional survey. J Rural Health 2023; 39:772-779. [PMID: 36575145 PMCID: PMC10293469 DOI: 10.1111/jrh.12737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE To evaluate how technology access affected substance use disorder (SUD) treatment prior to COVID-19 for people who use drugs in rural areas. METHODS The Rural Opioid Initiative (January 2018-March 2020) was a cross-sectional study of people with prior 30-day injection drug or nonprescribed opioid use from rural areas of 10 states. Using multivariable mixed-effect regression models, we examined associations between participant technology access and SUD treatment. FINDINGS Of 3,026 participants, 71% used heroin and 76% used methamphetamine. Thirty-five percent had no cell phone and 10% had no prior 30-day internet use. Having both a cell phone and the internet was associated with increased days of medication for opioid use disorder (MOUD) use (aIRR 1.29 [95% CI 1.11-1.52]) and a higher likelihood of SUD counseling in the prior 30 days (aOR 1.28 [95% CI 1.05-1.57]). Lack of cell phone was associated with decreased days of MOUD (aIRR 0.77 [95% CI 0.66-0.91]) and a lower likelihood of prior 30-day SUD counseling (aOR 0.77 [95% CI 0.62-0.94]). CONCLUSIONS Expanding US rural SUD treatment engagement via telemedicine may require increased cell phone and mobile network access.
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Affiliation(s)
- Dana Button
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Section of Addiction Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Ximena A. Levander
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Section of Addiction Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Ryan R. Cook
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Section of Addiction Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - William C. Miller
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Elizabeth M. Salisbury-Afshar
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA
| | - Judith I. Tsui
- Division of General Internal Medicine, University of Washington, Seattle, Washington, USA
| | - Umedjon Ibragimov
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Wiley D. Jenkins
- Department of Population Science and Policy, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Ryan P. Westergaard
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA
| | - P. Todd Korthuis
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Section of Addiction Medicine, Oregon Health & Science University, Portland, Oregon, USA
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O'Sullivan S, Schneider H. Comparing effects and application of telemedicine for different specialties in emergency medicine using the Emergency Talk Application (U-Sim ETA Trial). Sci Rep 2023; 13:13332. [PMID: 37587222 PMCID: PMC10432512 DOI: 10.1038/s41598-023-40501-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/11/2023] [Indexed: 08/18/2023] Open
Abstract
Telemedicine as a technology can support processes in the field of emergency medicine (EM) including therapies and diagnostics, but technically is often based on hardware solutions for local EM structures, especially when involving the field of pre-hospital EM. By developing an open-source, data protection compliant solution (EU GDPR and HIPAA) as well as using standardized web and open-source based technology the Emergency Talk Application (ETA) can be used as a technology that can connect emergency medical providers and include already available regional structures. By actively involving patients and connecting these with emergency or urgent care physicians ETA can be used not only as a teleconsultation system for paramedics and physicians, but in a wider network. Randomised simulation trial, comparing EM scenarios from the field of internal medicine, trauma and neurology. Participants were qualified as certified paramedics or emergency physicians (EP). Paramedics performed as ambulances crews and involved an EP if needed via ETA as Tele-Emergency Physicians (TEP). EP participated from a device of their choice, while being able to stay within their clinical workspace. From 141 scenarios 129 used ETA. Significant differences were found for the length of scenarios, duration of time the TEP was on scene, TEP arrival after scenario start, duration until TEP was called and the duration until a diagnosis was made. Also a strong positive and significant correlation between duration of the scenario and the time a TEP was bound could be described. Telemedicine is a technology that is increasingly used in the field of EM. Improving the use of telemedicine by using up-to date technology while allowing an integration of available technical and human resources is a challenge in the field of emergency medicine especially with its regional but also broad medical variety. When using one technical solution, understanding that different cases need a different medical and also telemedical approach can help in the understanding and improving therapies, diagnostics but also the involved processes and solutions. Such results are not only relevant for healthcare providers but especially by law and decision makers as to which type of solution could be introduced in each regional setting.
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Affiliation(s)
- Seán O'Sullivan
- Faculty of Health Sciences, Technische Hochschule Mittelhessen, Gießen, Germany.
| | - Henning Schneider
- Faculty of Health Sciences, Technische Hochschule Mittelhessen, Gießen, Germany
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Shi H, Wang Y, Dang B, Li D, Ma S, Wang X, Li Z, Hao W, Li C, Jiang Y, Yuan P, Chen L, Gong X, Wang Y, Wu X, Zhao Y, Wei Y. Reduced-visit antenatal care model combined with telemedicine for low-risk pregnant women: protocol for a randomised controlled trial. BMJ Open 2023; 13:e067110. [PMID: 37479506 PMCID: PMC10364145 DOI: 10.1136/bmjopen-2022-067110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/23/2023] Open
Abstract
INTRODUCTION Antenatal care (ANC) is a critical measure to reduce maternal and perinatal morbidity and mortality. However, there are issues of too many visits and cumbersome procedures of ANC in many maternity hospitals of China. In the past 2 years, reduced-visit ANC models combined with remote monitoring have been recommended and implemented at most hospitals in China during the COVID-19 pandemic. Nevertheless, due to limited evaluations of the cost-effectiveness, policy-makers remain confused on how to appropriately integrate online delivery strategies with routine models to improve ANC quality and efficiency sustainably at scale. This trial aims to evaluate the effectiveness, acceptability and cost of a reduced-visit ANC model combined with telemedicine. METHODS AND ANALYSIS A single-blind, randomised controlled trial will be conducted among low-risk pregnant women at Peking University Third Hospital in Beijing. 1476 patients (738 in each group) would be required, and they will be randomly assigned in a 1:1 ratio to receive the reduced-visit ANC combined with telemedicine services or the routine ANC. The primary outcome is the composite rate of adverse maternal and perinatal outcomes which will be extracted from the medical records. Secondary outcomes include acceptability of ANC models, which is assessed by satisfaction with ANC, pregnancy-related stress and ANC costs measured from the perspectives of both service providers and demanders. Both intention-to-treat and per-protocol analyses will be performed. Non-inferiority tests will be used to compare the two ANC models for the primary outcome. A cost-effectiveness analysis comparing the two ANC models will be conducted by estimating the incremental cost-effectiveness ratios. ETHICS AND DISSEMINATION This study was approved by the ethical review committee of the Peking University Third Hospital (Beijing, China). The results of this study will be published in peer-reviewed scientific journals and presented at relevant academic conferences. TRIAL REGISTRATION NUMBER NCT05290467.
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Affiliation(s)
- Huifeng Shi
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Centre for Obstetrics and Gynecology, Beijing, China
- National Centre for Healthcare Quality Management in Obstetrics, Beijing, China
| | - Ying Wang
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Centre for Obstetrics and Gynecology, Beijing, China
- National Centre for Healthcare Quality Management in Obstetrics, Beijing, China
| | - Binfei Dang
- School of Basic Medical Sciences, Peking University, Beijing, China
| | - Dantong Li
- Department of Maternal and Child Health, Peking University School of Public Health, Beijing, China
| | - Shang Ma
- Department of Maternal and Child Health, Peking University School of Public Health, Beijing, China
| | - Xiaoli Wang
- Department of Maternal and Child Health, Peking University School of Public Health, Beijing, China
| | - Zhen Li
- Department of Obstetrics and Gynecology, Beijing Dongcheng District Maternal and Child Health Hospital, Beijing, China
| | - Wenbin Hao
- Department of Obstetrics, The Second Affiliated Hospital of Hebei North University, Zhangjiakou, Hebei, China
| | - Changhong Li
- Department of Obstetrics, Hainan Women and Children's Medical Center, Haikou, Hainan, China
| | - Yuanhui Jiang
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Centre for Obstetrics and Gynecology, Beijing, China
| | - Pengbo Yuan
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Centre for Obstetrics and Gynecology, Beijing, China
| | - Lian Chen
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Centre for Obstetrics and Gynecology, Beijing, China
- National Centre for Healthcare Quality Management in Obstetrics, Beijing, China
| | - Xiaoli Gong
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Centre for Obstetrics and Gynecology, Beijing, China
| | - Yipei Wang
- Hospital Management Research Office, Peking University Third Hospital, Beijing, China
| | - Xinxia Wu
- Department of Medical Affairs, Peking University Third Hospital, Beijing, China
| | - Yangyu Zhao
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Centre for Obstetrics and Gynecology, Beijing, China
- National Centre for Healthcare Quality Management in Obstetrics, Beijing, China
| | - Yuan Wei
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Centre for Obstetrics and Gynecology, Beijing, China
- National Centre for Healthcare Quality Management in Obstetrics, Beijing, China
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Sattar S, Papadopoulos E, Smith GVH, Haase KR, Kobekyaa F, Tejero I, Bradley C, Nadler MB, Campbell KL, Santa Mina D, Alibhai SMH. State of research, feasibility, safety, acceptability, and outcomes examined on remotely delivered exercises using technology for older adult with cancer: a scoping review. J Cancer Surviv 2023:10.1007/s11764-023-01427-9. [PMID: 37418170 DOI: 10.1007/s11764-023-01427-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 06/28/2023] [Indexed: 07/08/2023]
Abstract
INTRODUCTION Technology-based exercise is gaining attention as a promising strategy for increasing physical activity (PA) in older adults with cancer (OACA). However, a comprehensive understanding of the interventions, their feasibility, outcomes, and safety is limited. This scoping review (1) assessed the prevalence and type of technology-based remotely delivered exercise interventions for OACA and (2) explored the feasibility, safety, acceptability, and outcomes in these interventions. METHODS Studies with participant mean/median age ≥ 65 reporting at least one outcome measure were included. Databases searched included the following: PubMed, CINAHL, Embase, Cochrane Library Online, SPORTDiscus, and PsycINFO. Multiple independent reviewers completed screening and data abstractions of articles in English, French, and Spanish. RESULTS The search yielded 2339 citations after removing duplicates. Following title and abstract screening, 96 full texts were review, and 15 were included. Study designs were heterogeneous, and sample sizes were diverse (range 14-478). The most common technologies used were website/web portal (n = 6), videos (n = 5), exergaming (n = 2), accelerometer/pedometer with video and/or website (n = 4), and live-videoconferencing (n = 2). Over half (9/15) of the studies examined feasibility using various definitions; feasibility outcomes were reached in all. Common outcomes examined include lower body function and quality of life. Adverse events were uncommon and minor were reported. Qualitative studies identified cost- and time-savings, healthcare professional support, and technology features that encourage engagement as facilitators. CONCLUSION Remote exercise interventions using technology appear to be feasible and acceptable in OACA. IMPLICATIONS FOR CANCER SURVIVORS Some remote exercise interventions may be a viable way to increase PA for OACA.
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Affiliation(s)
- S Sattar
- College of Nursing, University of Saskatchewan, 108-4400 4th Ave, Regina, SK, S4T 0H6, Canada.
| | - E Papadopoulos
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 610 University Ave, Toronto, ON, M5G 2C4, Canada
- Department of Medicine, University of Toronto, Toronto, 6 Queen's Park Crescent West, 3/F, Toronto, ON, M5S 3H2, Canada
| | - G V H Smith
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, 212 - 2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - K R Haase
- Faculty of Applied Science, School of Nursing, University of British Columbia, T201-2211, Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
| | - F Kobekyaa
- Faculty of Applied Science, School of Nursing, University of British Columbia, T201-2211, Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
| | - I Tejero
- Department of Geriatric Medicine, Parc de Salut Mar, Pg. Marítim de la Barceloneta, 25, 29, 08003, Barcelona, Spain
| | - C Bradley
- Library, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A2, Canada
| | - M B Nadler
- Department of Medicine, University of Toronto, Toronto, 6 Queen's Park Crescent West, 3/F, Toronto, ON, M5S 3H2, Canada
- Division of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, 610 University Ave, Toronto, ON, M5G 2C4, Canada
| | - K L Campbell
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, 212 - 2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - D Santa Mina
- Faculty of Kinesiology and Physical Education, University of Toronto, 55 Harbord Street, Toronto, ON, M5S 2W6, Canada
| | - S M H Alibhai
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 610 University Ave, Toronto, ON, M5G 2C4, Canada
- Department of Medicine, University of Toronto, Toronto, 6 Queen's Park Crescent West, 3/F, Toronto, ON, M5S 3H2, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College Street, Ste. 425, Toronto, ON, M5T 3M6, Canada
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Kim YJ, Aslam MS, Deng R, Leghari QA, Naseem S, Ul Hassan MM, Nadeem E, Qian L, Lkhagvasuren D. Intolerance of uncertainty across stress, anxiety, and depression among university students in Pakistan: A descriptive cross-sectional study. Heliyon 2023; 9:e16636. [PMID: 37274650 PMCID: PMC10238721 DOI: 10.1016/j.heliyon.2023.e16636] [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: 09/08/2022] [Revised: 05/15/2023] [Accepted: 05/23/2023] [Indexed: 06/06/2023] Open
Abstract
Background The mental health issues due to COVID-19, such as intolerance of uncertainty (IOU), anxiety, stress, and depression, have attracted extensive attention from researchers. The challenges for Pakistani university students could be worse than developed countries due to the lack of online courses/programs and online mental health support provided by academic institutions. Therefore, the current study aims to assess the intolerance of uncertainty, depression, anxiety, and stress of Pakistani university students after the second wave of COVID-19 and the relationship among these constructs. Methods A convenience cross-sectional sampling method was used to collect data from university students in Pakistan between January 2021 and April 2022 via a structured online questionnaire. The Descriptive analysis focused on frequencies, percentages, mean, and standard deviation (SD) were calculated on IOU-12 and DASS-21. Covariance for the research model and confirmatory factor analyses fit indices for the IOU-12 and DASS-21 were analyzed by AMOS statistical packages. Results As expected, anxiety, depression, and stress persist among Pakistani university students. On average, they report mild to moderate mental health problems regarding anxiety, depression, stress, and intolerance of uncertainty. Our results indicate a strong positive relationship among the three emotional distress components - anxiety, depression, and stress. However, our results suggest no significant relationship between IOU and the three subcomponents of emotional distress (anxiety, depression, and stress). Limitations First, the cross-sectional survey design means we cannot conclude on the causal relations. Second, the self-report questionnaire embeds subjectivity issues. Last, the generalizability of the sample to the whole student population in Pakistan is limited, considering the sampling method. Conclusion This study expanded the current knowledge in the psychological health domain (intolerance of uncertainty, anxiety, depression, and stress) due to the COVID-19 pandemic. In practice, higher education institutions should further mitigate university students' mental health issues. For researchers, our findings inspire future studies to delve into the relationship between IOU and mental health issues due to COVID-19 since our findings display contrary evidence for various reasons.
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Affiliation(s)
- Yun Jin Kim
- School of Traditional Chinese Medicine, Xiamen University Malaysia, Sepang, 43900, Malaysia
| | - Muhammad Shahzad Aslam
- School of Traditional Chinese Medicine, Xiamen University Malaysia, Sepang, 43900, Malaysia
| | - Ruolan Deng
- Department of Communication, University of Vienna, Vienna, 1090, Austria
| | - Qurratul ain Leghari
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Hamdard University, Karachi, 74600, Pakistan
| | - Solomon Naseem
- Faculty of Pharmacy, Ziauddin University, Karachi, Sindh, 75600, Pakistan
| | | | - Ejaz Nadeem
- Independent Researcher, Bahawalpur, Punjab, 63100, Pakistan
| | - Linchao Qian
- School of Traditional Chinese Medicine, Xiamen University Malaysia, Sepang, 43900, Malaysia
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Cunha AS, Pedro AR, Cordeiro JV. Facilitators and barriers to access hospital medical specialty telemedicine consultations during the COVID-19 pandemic: Systematic Review. J Med Internet Res 2023. [PMID: 37262124 DOI: 10.2196/44188] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND COVID-19 pandemic accelerated the digital transition in healthcare, which required a rapid adaptation of stakeholders. Telemedicine has emerged as an ideal tool to ensure continuity of care by allowing remote access to specialized medical services. However, its rapid implementation has exacerbated disparities in healthcare access, especially for the most vulnerable populations. OBJECTIVE To characterize the determinants factors (facilitators and barriers) of access to hospital medical specialty telemedicine consultations during the COVID-19 pandemic; to identify the main opportunities and challenges (technological, ethical, legal and/or social) generated by the use of telemedicine in the context of the COVID-19 pandemic. METHODS A systematic review was conducted according to PRISMA guidelines. Four databases (Scopus, Web of Science, PubMed and Cochrane COVID-19 Study Register) were searched for empirical studies published between January 3rd, 2020, and December 31st, 2021, using established criteria. The protocol of this review was registered and published in PROSPERO (CRD42022302825). A methodological quality assessment was performed, and results were integrated into a thematic synthesis. The identification of main opportunities and challenges was done by interpreting and aggregating the thematic synthesis results. RESULTS Of the 106 studies identified, 9 met the inclusion criteria and the intended quality characteristics. All studies were originally from the United States of America (USA). The following facilitating factors of telemedicine use were identified: health insurance coverage; prevention of SARS-CoV-2 infection; access to Internet services; access to technological devices; better management of work-life balance; and savings in travel costs. We identified the following barriers to telemedicine use: lack of access to Internet services; lack of access to technological devices; racial and ethnic disparities; low digital literacy; low income; age; language barriers; health insurance coverage; concerns about data privacy and confidentiality; geographic disparities; and need for complementary diagnostic tests or for the delivery of test results. CONCLUSIONS The facilitating factors and barriers identified in this systematic review present different opportunities and challenges, including those of technological nature (access to technological devices and internet services, level of digital literacy), sociocultural and demographic nature (ethnic and racial disparities, geographical disparities, language barriers, age), socioeconomic nature (income level and health insurance coverage), and ethical and legal nature (data privacy and confidentiality). To expand telemedicine access to hospital-based specialty medical consultations and provide high-quality care to all, including the most vulnerable communities, the challenges identified must be thoroughly researched and addressed with informed and dedicated responses. CLINICALTRIAL
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Affiliation(s)
- Ana Soraia Cunha
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal, Avenida Padre Cruz, Lisbon, PT
| | - Ana Rita Pedro
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal, Lisbon, PT
| | - João Valente Cordeiro
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal, Lisbon, PT
- Interdisciplinary Centre of Social Sciences (CICS.NOVA), Universidade NOVA de Lisboa, Lisbon, Portugal, Lisbon, PT
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Kumra T, Amundsen DB, Mullins A, Hindman DJ, Hughes HK, Pahwa AK. Telehealth Curricula in the Pediatric Core Clerkship: Results From a Survey of Clerkship Directors. Cureus 2023; 15:e39200. [PMID: 37337508 PMCID: PMC10276772 DOI: 10.7759/cureus.39200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2023] [Indexed: 06/21/2023] Open
Abstract
OBJECTIVE Given the increasing prevalence of telehealth, medical students require dedicated instruction in the practice of high-quality telehealth. This study characterizes telehealth practices and curricula in pediatric core clerkships across the United States and Canada. METHODS We surveyed pediatric core clerkship directors and site directors through the 2020 Council on Medical Student Education in Pediatrics (COMSEP) annual member survey. We analyzed the results using descriptive statistics. RESULTS Of 104 medical schools represented, 28 responded (26.9%). Directors reported students spent little time on telehealth during their pediatric core clerkships (average 8.2% of clerkship; SD 10.4). Only 10.7% (n=3) of clerkships had dedicated telehealth curricula. The instructional methods, content, and modes of evaluation varied across the clerkships' curricula. Barriers to implementation of telehealth curricula included lack of dedicated time in the existing curriculum (64.0%), lack of faculty time to teach (44.0%), lack of curricular materials (44.0%), students not participating in telehealth activities (40.0%) and lack of faculty expertise (36.0%). CONCLUSIONS Most pediatric core clerkships do not include dedicated telehealth curricula, and the characteristics of existing curricula vary. Considering the rapid adoption of telemedicine, pediatric core clerkships merit additional support and guidance for the training of medical students in telehealth practice.
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Affiliation(s)
- Tina Kumra
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Danielle B Amundsen
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Alexa Mullins
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Daniel J Hindman
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Helen K Hughes
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Amit K Pahwa
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, USA
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Gilmore D, Harris L, Hanks C, Coury D, Moffatt-Bruce S, Garvin JH, Hand BN. "Giving the patients less work": A thematic analysis of telehealth use and recommendations to improve usability for autistic adults. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:1132-1141. [PMID: 36325713 PMCID: PMC10101865 DOI: 10.1177/13623613221132422] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
LAY ABSTRACT Real-time telehealth visits, called "virtual visits," are live video chats between patients and healthcare professionals. There are lots of steps involved in setting up a virtual visit, which may be difficult for some autistic adults. We interviewed 7 autistic adults, 12 family members of autistic adults, and 6 clinic staff from one clinic in the United States. Our goal was to understand their experiences with virtual visits and see how we can make virtual visits easier to use. We re-read text from the interviews to organize experiences and advice that was shared into topics. We found that autistic adults (or their family members) had to connect with clinic staff many times by phone or online over several days to set up a virtual visit. Participants said that having more experience with technology and using the online patient portal made virtual visits easier to use. But, having issues with technology before the visit could make autistic adults and family members anxious. Clinic staff said it was hard for them to meet the needs of people who were using virtual visits and those who were being seen in person at the clinic. Participants recommended reducing the number of calls between staff and autistic adults or family members using the online patient portal instead. Participants also recommended reminder messages, instruction videos, and approximate wait-times to help autistic adults and family members know what to expect for the virtual visit. Our results are based on peoples' experiences at one clinic, but could help other clinics make virtual visits easier to use for autistic adults and their family members.
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Affiliation(s)
| | | | - Christopher Hanks
- The Ohio State University, USA
- Center for Autism Services and Transition, The Ohio State University, USA
| | - Daniel Coury
- The Ohio State University, USA
- Nationwide Children’s Hospital, USA
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Ritzwoller DP, Goodrich GW, Tavel HM, Odelberg MR, Davis TL, Gander JC, McCracken CE, Weinfield NS, Roblin DW. Patient Factors Associated With Use of Adult Primary Care and Virtual Visits During the COVID-19 Pandemic. Med Care 2023; 61:S12-S20. [PMID: 36893414 PMCID: PMC9994567 DOI: 10.1097/mlr.0000000000001792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
BACKGROUND The delivery of adult primary care (APC) shifted from predominately in-person to modes of virtual care during the COVID-19 pandemic. It is unclear how these shifts impacted the likelihood of APC use during the pandemic, or how patient characteristics may be associated with the use of virtual care. METHODS A retrospective cohort study using person-month level datasets from 3 geographically disparate integrated health care systems was conducted for the observation period of January 1, 2020, through June 30, 2021. We estimated a 2-stage model, first adjusting for patient-level sociodemographic, clinical, and cost-sharing factors, using generalized estimating equations with a logit distribution, along with a second-stage multinomial generalized estimating equations model that included an inverse propensity score treatment weight to adjust for the likelihood of APC use. Factors associated with APC use and virtual care use were separately assessed for the 3 sites. RESULTS Included in the first-stage models were datasets with total person-months of 7,055,549, 11,014,430, and 4,176,934, respectively. Older age, female sex, greater comorbidity, and Black race and Hispanic ethnicity were associated with higher likelihood of any APC use in any month; measures of greater patient cost-sharing were associated with a lower likelihood. Conditional on APC use, older age, and adults identifying as Black, Asian, or Hispanic were less likely to use virtual care. CONCLUSIONS As the transition in health care continues to evolve, our findings suggest that to ensure vulnerable patient groups receive high quality health care, outreach interventions to reduce barriers to virtual care use may be warranted.
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Affiliation(s)
| | - Glenn W. Goodrich
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO
| | - Heather M. Tavel
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO
| | | | - Teaniese L. Davis
- Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta, GA
| | - Jennifer C. Gander
- Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta, GA
| | | | - Nancy S. Weinfield
- Kaiser Permanente Mid-Atlantic Permanente Research Institute, Rockville, MD
| | - Douglas W. Roblin
- Kaiser Permanente Mid-Atlantic Permanente Research Institute, Rockville, MD
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Jiang Y, Nuerdawulieti B, Chen Z, Guo J, Sun P, Chen M, Li J. Effectiveness of patient decision aid supported shared decision-making intervention in in-person and virtual hybrid pulmonary rehabilitation in older adults with chronic obstructive pulmonary disease: A pilot randomized controlled trial. J Telemed Telecare 2023:1357633X231156631. [PMID: 36919365 DOI: 10.1177/1357633x231156631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
INTRODUCTION Tele-pulmonary rehabilitation is increasingly advocated but cannot completely substitute for in-person services for chronic conditions. Adherence to Pulmonary rehabilitation (PR) remains low in chronic obstructive pulmonary disease (COPD) patients. Shared decision-making (SDM) promotes patients' participation in PR decisions and helps patients and healthcare providers to jointly make decisions that patients are informed and aligned with patient preferences and values, which are critical for patient adherence to PR. OBJECTIVE This study aimed to develop a hybrid in-person and virtual model of home-based PR services for older COPD patients and study the effectiveness of the patient decision aid (PDA)-supported recurring SDM intervention on patient adherence to PR, rehabilitation outcomes, and decision-related outcomes, as well as to explore the mechanisms of the intervention on PR adherence. METHODS A total of 78 older COPD patients were randomly assigned to the PR group (n = 39) or PDA-PR group (n = 39). Both groups were conducted hybrid in-person and virtual PR intervention for 3 months. The primary outcomes were patients' quality of life and PR adherence. The secondary outcomes were dyspnea symptoms, exercise self-efficacy, knowledge, and decision-related outcomes. RESULTS A total of 72 participants completed the 3-month PR program. There were statistically significant differences in PR adherence (p = 0.033), COPD assessment test (CAT) scores (p = 0.016), PR knowledge (p < 0.001), decision self-efficacy (p < 0.001), decision conflict (p < 0.001), and decision regret scores (p = 0.027) between the two groups. The modified Medical Research Council Dyspnoea scale (mMRC) score was significantly decreased only in PDA-PR group (p = 0.011). No statistically significant differences were observed in St George's Respiratory Questionnaire (SGRQ) score (p = 0.078), Exercise Self-Regulatory Efficacy Scale (Ex-SRES) score (p = 0.29) and COPD knowledge (p = 0.086) between the two groups. PR value score had a significant effect on adherence to PR (p = 0.007) and CAT score (p = 0.028). CONCLUSIONS PDA supported recurring SDM intervention was helpful in maintaining older COPD patients' PR adherence and had advantages in improving quality of life, enhancing PR knowledge, decision self-efficacy, and reducing decision conflict and decision regret, but did not improve SGRQ and Ex-SRES. PR value score influenced patients' rehabilitation adherence and quality of life. TRIAL REGISTRATION Chinese Clinical Trial Registry (ChiCTR): ChiCTR1900028563; http://apps.who.int/trialsearch/default.aspx.
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Affiliation(s)
- Yuyu Jiang
- Department of Nursing, Research Office of Chronic Disease Management and Rehabilitation, Wuxi School of Medicine, 66374Jiangnan University, Wuxi, China
| | - Baiyila Nuerdawulieti
- Department of Nursing, Research Office of Chronic Disease Management and Rehabilitation, Wuxi School of Medicine, 66374Jiangnan University, Wuxi, China
| | - Zhongyi Chen
- Department of Nursing, Research Office of Chronic Disease Management and Rehabilitation, Wuxi School of Medicine, 66374Jiangnan University, Wuxi, China
| | - Jianlan Guo
- Department of Nursing, Research Office of Chronic Disease Management and Rehabilitation, Wuxi School of Medicine, 66374Jiangnan University, Wuxi, China
| | - Pingping Sun
- Department of Nursing, Research Office of Chronic Disease Management and Rehabilitation, Wuxi School of Medicine, 66374Jiangnan University, Wuxi, China
| | - Mengjie Chen
- Department of Nursing, Research Office of Chronic Disease Management and Rehabilitation, Wuxi School of Medicine, 66374Jiangnan University, Wuxi, China
| | - Jinping Li
- Department of Public Health and Preventive Medicine, Wuxi School of Medicine, 66374Jiangnan University, Wuxi, China
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El-Mazahy H, Mekky J, Elshaer N. Medical professionals' job satisfaction and telemedicine readiness during the COVID-19 pandemic: solutions to improve medical practice in Egypt. J Egypt Public Health Assoc 2023; 98:5. [PMID: 36878998 PMCID: PMC9988361 DOI: 10.1186/s42506-023-00127-7] [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: 04/01/2022] [Accepted: 01/24/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND The COVID-19 pandemic has impacted medical professionals' job satisfaction and was a call to adopt telemedicine. Finding out how far medical professionals are satisfied and ready to use telemedicine would be important to improve medical practice. METHODS Data was collected from 959 medical professionals from both the governmental and private health sectors in Egypt in 2021 using a specifically designed online questionnaire, to evaluate job satisfaction, perception of telemedicine, and propose solutions to improve medical practice. RESULTS The study revealed low to moderate job satisfaction at governmental (27.2%) and private (58.7%) sectors. Underpayment was the most reported challenge at both sectors (37.8% and 28.3%, respectively). Dissatisfaction with government salary was independently predicted by working at the Ministry of Health and Population (OR = 5.54, 95%CI = 2.39,12.8; p < 0.001). Wage increase (46.10%), medical training of professionals (18.1%), and management of non-human resources (14.4%) were the most proposed solutions to improve medical practice in Egypt. During the COVID-19 pandemic, 90.7% of medical professionals had practiced telemedicine with moderate level of perception of its benefits (56%). CONCLUSIONS During the COVID-19 pandemic, medical professionals reported low to moderate job satisfaction and a moderate level of perception of telemedicine. It is recommended to analyze the healthcare financing system and provide continuous training of medical professionals to improve medical practice in Egypt.
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Affiliation(s)
| | - Jaidaa Mekky
- Department of Neuropsychiatry, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Noha Elshaer
- Industrial Medicine and Occupational Health, Department of Community Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
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Li B, Gillmeyer KR, Molloy-Paolillo B, Vimalananda VG, Elwy AR, Wiener RS, Rinne ST. Scoping Review of Pulmonary Telemedicine Consults: Current Knowledge and Research Gaps. Ann Am Thorac Soc 2023; 20:456-465. [PMID: 36490386 PMCID: PMC9993154 DOI: 10.1513/annalsats.202205-404oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 12/09/2022] [Indexed: 12/13/2022] Open
Abstract
Rationale: Telemedicine consults, including video consults, telephone consults, electronic consults, and virtual conferences, may be particularly valuable in the management of chronic pulmonary diseases, but there is limited guidance on best practices for pulmonary telemedicine consults. Objectives: This scoping review aims to identify, characterize, and analyze gaps in the published literature on telemedicine consults health providers use to manage patients with chronic pulmonary diseases. Methods: We searched PubMed, Embase, Web of Science, and Cochrane Library from database origin through July 10, 2021. We included manuscripts describing applications of telemedicine consults for patients with chronic pulmonary diseases (asthma, chronic obstructive pulmonary disease, lung cancer, pulmonary hypertension, and interstitial lung disease). We restricted our review to full-length articles published in English about provider-led (as opposed to nurse-led) telemedicine consults. Results: Our search yielded 3,118 unique articles; 27 articles met the inclusion criteria. All telemedicine consult modalities and chronic pulmonary conditions were well represented in the review except for pulmonary hypertension and interstitial lung disease, which were represented by one and no articles, respectively. Most articles described a small, single-center, observational study that focused on the acceptability, feasibility, use, and/or clinical effectiveness of the telemedicine consult. Few studies had objectively measured clinical outcomes or included a comparator group, and none compared telemedicine consult modalities against one another. Conclusions: Our scoping review identified limited literature describing pulmonary telemedicine consults and highlighted several gaps in the literature that warrant increased attention. Providers treating chronic pulmonary diseases are left with limited guidance on best practices for telemedicine consults.
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Affiliation(s)
| | | | - Brianne Molloy-Paolillo
- Center for Healthcare Organization and Implementation Research, Veterans Affairs Bedford Healthcare System, Bedford, Massachusetts
| | - Varsha G. Vimalananda
- Section of Endocrinology, Diabetes, Nutrition & Weight Management, Boston University School of Medicine, Boston, Massachusetts
- Center for Healthcare Organization and Implementation Research, Veterans Affairs Bedford Healthcare System, Bedford, Massachusetts
| | - A. Rani Elwy
- Center for Healthcare Organization and Implementation Research, Veterans Affairs Bedford Healthcare System, Bedford, Massachusetts
- Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island; and
| | - Renda Soylemez Wiener
- The Pulmonary Center, and
- Center for Healthcare Organization and Implementation Research, Veterans Affairs Boston Healthcare System, Boston, Massachusetts
| | - Seppo T. Rinne
- The Pulmonary Center, and
- Center for Healthcare Organization and Implementation Research, Veterans Affairs Bedford Healthcare System, Bedford, Massachusetts
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Thawani SP, Minen MT, Stainman RS, Friedman S, Bhatt JM, Foo FYA, Torres DM, Weinberg HJ, Kim NH, Levitan V, Cardiel MI, Zakin E, Conway JM, Kurzweil AM, Hasanaj L, Galetta SL, Balcer LJ, Busis NA. Neurologists' Evaluations of Experience and Effectiveness of Teleneurology Encounters. Telemed J E Health 2023; 29:442-453. [PMID: 35834603 DOI: 10.1089/tmj.2021.0551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background and Objectives: To better understand neurologists' assessments of the experiences and effectiveness of teleneurology encounters. Methods: After completing an audio-video telehealth visit with verbally consenting patients, neurologists recorded their evaluations of the encounter. Data were analyzed using standard quantitative and qualitative techniques. Results: The study included unique encounters between 187 patients and 11 neurologists. The mean patient age was 49 ± 17.5 years. Two thirds of patients (66.8%, 125/187) were female. One third of patients (33.2%; 62) were new patients. The most common patient complaints were headache (69/187, 36.9%), focal and generalized numbness or tingling (21, 11.2%), memory difficulty (15, 8%), spine-related symptoms (12, 6.4%), and vertigo (11, 5.9%). Neurologists reported that they completed a virtual examination that provided enough information for medical decision-making in 94.9% of encounters (169/178, 9 missing responses). Fourteen of 25 examination elements important for medical decision-making could be performed sufficiently during virtual encounters. Examination assistance was needed for 16.4% (30/183) of patients, who were, on average, 17.3 years older than those who did not require assistance (62.9 years vs. 45.6 years, p = 0.0002). In 19.1% (34/178) of encounters, neurologists learned clinically relevant information from seeing patients in their homes. Neurologists' assessments of the effectiveness of encounters were not related to the presence (97.2%, 35/36 effective) or absence (95%, 134/141 effective) of technical difficulties (p = 0.5729) in 177 encounters (10 missing responses). Discussion: Neurologists reported that nearly 95% of teleneurology encounters were effective despite limitations of the virtual examination, occasional need for patient assistance, and technical difficulties.
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Affiliation(s)
- Sujata P Thawani
- Department of Neurology and NYU Langone Health, New York, New York, USA
| | - Mia T Minen
- Department of Neurology and NYU Langone Health, New York, New York, USA.,Department of Population Health, NYU Langone Health, New York, New York, USA
| | - Rebecca S Stainman
- Department of Neurology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Steven Friedman
- Department of Population Health, NYU Langone Health, New York, New York, USA
| | - Jaydeep M Bhatt
- Department of Neurology and NYU Langone Health, New York, New York, USA
| | - Farng-Yang A Foo
- Department of Neurology and NYU Langone Health, New York, New York, USA
| | - Daniel M Torres
- Department of Neurology and NYU Langone Health, New York, New York, USA
| | - Harold J Weinberg
- Department of Neurology and NYU Langone Health, New York, New York, USA
| | - Nina H Kim
- Department of Neurology and NYU Langone Health, New York, New York, USA
| | - Valeriya Levitan
- Department of Neurology and NYU Langone Health, New York, New York, USA
| | - Myrna I Cardiel
- Department of Neurology and NYU Langone Health, New York, New York, USA
| | - Elina Zakin
- Department of Neurology and NYU Langone Health, New York, New York, USA
| | - Jenna M Conway
- Department of Neurology and NYU Langone Health, New York, New York, USA
| | | | - Lisena Hasanaj
- Department of Neurology and NYU Langone Health, New York, New York, USA
| | - Steven L Galetta
- Department of Neurology and NYU Langone Health, New York, New York, USA.,Department of Ophthalmology, NYU Langone Health, New York, New York, USA
| | - Laura J Balcer
- Department of Neurology and NYU Langone Health, New York, New York, USA.,Department of Population Health, NYU Langone Health, New York, New York, USA.,Department of Ophthalmology, NYU Langone Health, New York, New York, USA
| | - Neil A Busis
- Department of Neurology and NYU Langone Health, New York, New York, USA
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Tuna B, Avci OH. Qualitative analysis of university counselors' online counseling experiences during the COVID-19 pandemic. CURRENT PSYCHOLOGY 2023; 42:8489-8503. [PMID: 37193098 PMCID: PMC9969378 DOI: 10.1007/s12144-023-04358-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2023] [Indexed: 03/02/2023]
Abstract
This study aimed to reflect on counselors' experiences and the adaptation processes in university counseling centers during the COVID-19 pandemic. Accordingly, 15 counselors and psychologists working at different counseling centers were reached and interviewed. Thematic analysis showed that participants had to adapt to changes brought by the pandemic to continue their services. The adaptation of counseling centers to online practices showed differences according to administrative decisions and technical capacities. As a result of the urgent need to continue providing psychological help, participants moved to online practices, which caused professional and social life changes. Participant attitudes to online counseling were mainly positive. Since students had to move back to their family homes during the pandemic, limited confidentiality was the main problem aside from technological glitches in online sessions. Counselors encountered personal and professional challenges as a result of the ongoing counseling sessions and listed the self-care activities they used.
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Affiliation(s)
- Burak Tuna
- University Counseling Center, Kadir Has University, Cibali Campus, 34083 Cibali/Istanbul, Turkey
| | - Ozlem Haskan Avci
- Educational Sciences, Division of Counseling and Guidance, Hacettepe University, 06800 Beytepe/Ankara, Turkey
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Bottoni E, Mangiameli G, Testori A, Piccioni F, Giudici VM, Voulaz E, Ruggieri N, Dalla Corte F, Crepaldi A, Goretti G, Vanni E, Pisarra M, Cariboni U, Alloisio M, Cecconi M. Early Hospital Discharge on Day Two Post Robotic Lobectomy with Telehealth Home Monitoring: A Pilot Study. Cancers (Basel) 2023; 15:cancers15041146. [PMID: 36831489 PMCID: PMC9954553 DOI: 10.3390/cancers15041146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/02/2023] [Accepted: 02/05/2023] [Indexed: 02/15/2023] Open
Abstract
Despite the adoption of enhanced recovery programs, the reported postoperative length of stay after robotic surgery is 4 days even in highly specialized centers. We report preliminary results of a pilot study for a new protocol of early discharge (on day 2) with telehealth home monitoring after robotic lobectomy for lung cancer. All patients with a caregiver were discharged on postoperative day 2 with a telemonitoring device if they satisfied specific discharge criteria. Teleconsultations were scheduled once in the afternoon of post-operative day 2, twice on postoperative day 3, and then once a day until the chest tube removal. Post-discharge vital signs were recorded by patients at least four times daily through the device and were available for consultation by two surgeons through phone application. In case of sudden variation of vital signs or occurrence of adverse events, a direct telephone line was available for patients as well as a protected re-hospitalization path. Primary outcome was the safety evaluated by the occurrence of post-discharge complications and readmissions. Secondary outcome was the evaluation of resources optimization (hospitalization days) maintaining the standard of care. During the study period, twelve patients satisfied all preoperative clinical criteria to be enrolled in our protocol. Two of twelve enrolled patients were successively excluded because they did not satisfy discharge criteria on postoperative day 2. During telehealth home monitoring a total of 27/427 vital-sign measurements violated the threshold in seven patients. Among the threshold violations, only 1 out of 27 was a critical violation and was managed at home. No postoperative complication occurred neither readmission was needed. A mean number of three hospitalization days was avoided and an estimated economic benefit of about EUR 500 for a single patient was obtained if compared with patients submitted to VATS lobectomy in the same period. These preliminary results confirm that adoption of telemonitoring allows, in selected patients, a safe discharge on postoperative day 2 after robotic surgery for early-stage NSCLC. A potential economic benefit could derive from this protocol if this data will be confirmed in larger sample.
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Affiliation(s)
- Edoardo Bottoni
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Giuseppe Mangiameli
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
- Correspondence: ; Tel.: +39-02-82247585
| | - Alberto Testori
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Federico Piccioni
- Anesthesia Unit 1, Department of Anesthesia and Intensive Care, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Veronica Maria Giudici
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Emanuele Voulaz
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
| | - Nadia Ruggieri
- Anesthesia Unit 1, Department of Anesthesia and Intensive Care, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Francesca Dalla Corte
- Anesthesia Unit 1, Department of Anesthesia and Intensive Care, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Alessandro Crepaldi
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Giulia Goretti
- Quality Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Elena Vanni
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
- Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Martina Pisarra
- Quality Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
- Department of Economics, Management and Quantitative Methods, University of Milan, Via Conservatorio 7, 20122 Milan, Italy
| | - Umberto Cariboni
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Marco Alloisio
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
| | - Maurizio Cecconi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
- Anesthesia Unit 1, Department of Anesthesia and Intensive Care, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
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Follow-Up, Safety, and Satisfaction with Tele-bariatric Follow-Up Implemented During the COVID-19 French Lockdown: a 2-Year Follow-Up Study. Obes Surg 2023; 33:1083-1091. [PMID: 36757646 PMCID: PMC9910261 DOI: 10.1007/s11695-023-06485-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/22/2023] [Accepted: 01/27/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND The COVID-19 pandemic was initially responsible for a global restricted access to healthcare resources including the follow-up of at-risk populations such as bariatric patients. We substituted face-to-face bariatric follow-up outpatient clinics (FTFC) with teleclinics (TC) during the lockdown. MATERIAL AND METHODS We retrospectively reviewed data collected on all patients scheduled for TC during the French lockdown period (March 15 to May 15, 2020) (N = 87). Our aims were to present the patients' outcomes at one and 2 years post-TC implementation and describe patient/practitioner satisfaction. RESULTS Seven (8%) patients required FTFC, and 80 (92%) underwent TC (study population) for preoperative bariatric assessment (N = 3) and postoperative follow-up (N = 77) after 23.6 ± 29 months following surgery. TC was performed with video and audio (N = 46; 57.5%) or audio alone when video was impossible (N = 34; 42.5%). Sixteen (20%) patients presented at least one complication identified at the first TC and were managed accordingly. There were no readmissions at 30/90 days post-TC. At 1-year after the first TC, overall follow-up rate was 94.9% (TC: 73% vs FTFC: 27%). Patients surveyed on the main advantages of TC over FTFC (N = 46) cited: saving time (97.8%) at a mean 3.9 ± 6.4 h saved per TC, work-advantages (94.3%), and comparable relevance of TC (84.8%). At 2 years post-TC implementation, follow-up rate was 93.5% and satisfaction rate was 80%, with 33% of patients preferring to return to FTFC. CONCLUSIONS TC is a satisfactory substitute for FTFC, enabling continued bariatric follow-up during and beyond the pandemic setting without compromising patient safety. However, the modest satisfaction outcomes at 2 years highlight a need to discuss follow-up preferences in order to achieve optimal outcomes.
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Fernández-Prada M, Cano-García P, Alonso-Penanes P, Zapico-Baragaño MJ, Giménez-Gómez P, Lana A. Preliminary evaluation of an inter-professional e-consultation on vaccines. J Telemed Telecare 2023; 29:111-116. [PMID: 33176541 DOI: 10.1177/1357633x20970077] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The aim of this study was to assess the preliminary effectiveness and acceptability of an inter-professional e-consultation on vaccines. We used a quasi-experimental design to introduce an application in electronic health records that allowed primary health providers to launch e-consults to the hospital vaccines unit. A total of 135 e-consults were received during 10 months. E-consults were more frequently about subjects with chronic diseases (82.2%). Most of the e-consults were global (60.7%), that is, to revise a patient's complete vaccination schedule, whereas 39.3% were specific, that is, to request information regarding a concrete vaccine or serology, with hepatitis vaccines leading the ranking (42.9%). The e-consultation avoided hospital referral in 85.4% of the global e-consults and in 100% of the specific e-consults. Indicators of acceptability were all above nine points (10 points indicated the maximum). The best-rated aspect was the level of recommendation (9.7 ± 0.68 points). In summary, linking primary health-care providers with specialists in vaccines through an e-consultation tool is effective and well-accepted by users.
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Affiliation(s)
- María Fernández-Prada
- Vaccines Unit, Preventive Medicine and Public Health Department, Vital Álvarez-Buylla Hospital, Health Care Service of Asturias, Spain.,Healthcare Research Area, Health Research Institute of Asturias (ISPA), Spain
| | - Paula Cano-García
- Preventive Medicine and Public Health Department, School of Medicine and Health Sciences, University of Oviedo, Spain
| | - Paula Alonso-Penanes
- Preventive Medicine and Public Health Department, School of Medicine and Health Sciences, University of Oviedo, Spain
| | - María J Zapico-Baragaño
- Vaccines Unit, Preventive Medicine and Public Health Department, Vital Álvarez-Buylla Hospital, Health Care Service of Asturias, Spain
| | - Pia Giménez-Gómez
- Health Services Organisation Department, Health Service of the Principality of Asturias, Spain
| | - Alberto Lana
- Healthcare Research Area, Health Research Institute of Asturias (ISPA), Spain.,Preventive Medicine and Public Health Department, School of Medicine and Health Sciences, University of Oviedo, Spain
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Lovis C, Hefner J, Chen C, Huang Y, Wang X, Yang Q, Zhu X, Zhang X, Hao M, Shui L. Developing a Capsule Clinic-A 24-Hour Institution for Improving Primary Health Care Accessibility: Evidence From China. JMIR Med Inform 2023; 11:e41212. [PMID: 36622737 PMCID: PMC9871876 DOI: 10.2196/41212] [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: 07/19/2022] [Revised: 11/18/2022] [Accepted: 12/08/2022] [Indexed: 01/10/2023] Open
Abstract
Telehealth is an effective combination of medical service and intelligent technology. It can improve the problem of remote access to medical care. However, an imbalance in the allocation of health resources still occurs. People spend more time and money to access higher-quality services, which results in inequitable access to primary health care (PHC). At the same time, patients' usage of telehealth services is limited by the equipment and their own knowledge, and the PHC service suffers from low usage efficiency and lack of service supply. Therefore, improving PHC accessibility is crucial to narrowing the global health care coverage gap and maintaining health equity. In recent years, China has explored several new approaches to improve PHC accessibility. One such approach is the capsule clinic, an emerging institution that represents an upgraded version of the internet hospital. In coordination with the United Nations, the Yinzhou district of Ningbo city in Zhejiang, China, has been testing this new model since 2020. As of October 2022, the number of applications in Ningbo was 15, and the number of users reached 12,219. Unlike internet hospitals, the entire process-from diagnosis to prescription services-can be completed at the capsule clinic. The 24-hour telehealth service could also solve transportation problems and save time for users. Big data analysis can accurately identify regional populations' PHC service needs and improve efficiency in health resource allocation. The user-friendly, low-cost, and easily accessible telehealth model is of great significance. Installation of capsule clinics would improve PHC accessibility and resolve the uneven distribution of health resources to promote health equity.
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Affiliation(s)
| | | | - Chun Chen
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
| | - Yunyun Huang
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
| | - Xiaoyi Wang
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
| | - Qingren Yang
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
| | - Xuebo Zhu
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
| | - Xiangyang Zhang
- Engineering Research Center of Intelligent Medicine (2016E10011), The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Mo Hao
- School of Public Health, Fudan University, Shanghai, China
| | - Liming Shui
- Yinzhou District Health Bureau, Ningbo, China
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Telehealth for COVID-19: A Conceptual Framework. JOURNAL OF HEALTHCARE ENGINEERING 2023; 2023:3679829. [PMID: 36818384 PMCID: PMC9929206 DOI: 10.1155/2023/3679829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/02/2022] [Accepted: 05/12/2022] [Indexed: 02/10/2023]
Abstract
The world has been going through the global crisis of the coronavirus (COVID-19). It is a challenging situation for every country to tackle its healthcare system. COVID-19 spreads through physical contact with COVID-positive patients and causes potential damage to the country's health and economy system. Therefore, to overcome the chance of spreading the disease, the only preventive measure is to maintain social distancing. In this vulnerable situation, virtual resources have been utilized in order to maintain social distance, i.e., the telehealth system has been proposed and developed to access healthcare services remotely and manage people's health conditions. The telehealth system could become a regular part of our healthcare system, and during any calamity or natural disaster, it could be used as an emergency response to deal with the catastrophe. For this purpose, we proposed a conceptual telehealth framework in response to COVID-19. We focused on identifying critical issues concerning the use of telehealth in healthcare setups. Furthermore, the factors influencing the implementation of the telehealth system have been explored in detail. The proposed telehealth system utilizes artificial intelligence and data science to regulate and maintain the system efficiently. Before implementing the telehealth system, it is required that prearrangements be made, such as appropriate funding measures, the skills to know technological usage, training sessions, and staff endorsement. The barriers and influencing factors provided in this article can be helpful for future developments in telehealth systems and for making fruitful progress in fighting pandemics like COVID-19. At the same time, the same approach can be used to save the lives of many frontline workers.
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