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Pamplin JC, Veazey SR, Barczak S, Fonda SJ, Serio-Melvin ML, Ross KS, Colombo CJ. Randomized Controlled Trial of Telementoring During Resource-Limited Patient Care Simulation Improves Caregiver Performance and Patient Survival. Crit Care Explor 2024; 6:e1090. [PMID: 38736901 PMCID: PMC11086961 DOI: 10.1097/cce.0000000000001090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024] Open
Abstract
OBJECTIVES To determine the impact of telementoring on caregiver performance during a high-fidelity medical simulation model (HFMSM) of a critically ill patient in a resource-limited setting. DESIGN A two-center, randomized, controlled study using a HFMSM of a patient with community-acquired pneumonia complicated by acute respiratory distress syndrome. SETTING A notional clinic in a remote location staffed by a single clinician and nonmedical assistant. PARTICIPANTS Clinicians with limited experience managing critically ill patients. INTERVENTIONS Telemedicine (TM) support. MEASUREMENTS The primary outcome was clinical performance as measured by accuracy, reliability, and efficiency of care. Secondary outcomes were patient survival, procedural quality, subjective assessment of the HFMSM, and perceived workload. MAIN RESULTS TM participants (N = 11) performed better than non-TM (NTM, N = 12) in providing expected care (accuracy), delivering care more consistently (reliability), and without consistent differences in efficiency (timeliness of care). Accuracy: TM completed 91% and NTM 42% of expected tasks and procedures. Efficiency: groups did not differ in the mean (± sd) minutes it took to obtain an advanced airway successfully (TM 15.2 ± 10.5 vs. NTM 22.8 ± 8.4, p = 0.10) or decompress a tension pneumothorax with a needle (TM 0.7 ± 0.5 vs. NTM 0.6 ± 0.9, p = 0.65). TM was slower than NTM in completing thoracostomy (22.3 ± 10.2 vs. 12.3 ± 4.8, p = 0.03). Reliability: TM performed 13 of 17 (76%) tasks with more consistent timing than NTM. TM completed 68% and NTM 29% of procedural quality metrics. Eighty-two percent of the TM participants versus 17% of the NTM participants simulated patients survived (p = 0.003). The groups similarly perceived the HFMSM as realistic, managed their patients with personal ownership, and experienced comparable workload and stress. CONCLUSIONS Remote expertise provided with TM to caregivers in resource-limited settings improves caregiver performance, quality of care, and potentially real patient survival. HFMSM can be used to study interventions in ways not possible with real patients.
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Affiliation(s)
- Jeremy C Pamplin
- The U.S. Army Telemedicine and Advanced Technology Research Center, Frederick, MD
- Department of Medicine, Department of Emergency and Operational Medicine, The Uniformed Services University, Bethesda, MD
- Department of Emergency and Operational Medicine, The Uniformed Services University, Bethesda, MD
- The U.S. Army Institute of Surgical Research, San Antonio, TX
- The Geneva Foundation, Tacoma, WA
| | - Sena R Veazey
- The U.S. Army Institute of Surgical Research, San Antonio, TX
| | | | | | | | | | - Christopher J Colombo
- Department of Medicine, Department of Emergency and Operational Medicine, The Uniformed Services University, Bethesda, MD
- The U.S. Army Institute of Surgical Research, San Antonio, TX
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2
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Than J, Sim PY, Muttuvelu D, Ferraz D, Koh V, Kang S, Huemer J. Teleophthalmology and retina: a review of current tools, pathways and services. Int J Retina Vitreous 2023; 9:76. [PMID: 38053188 DOI: 10.1186/s40942-023-00502-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 10/02/2023] [Indexed: 12/07/2023] Open
Abstract
Telemedicine, the use of telecommunication and information technology to deliver healthcare remotely, has evolved beyond recognition since its inception in the 1970s. Advances in telecommunication infrastructure, the advent of the Internet, exponential growth in computing power and associated computer-aided diagnosis, and medical imaging developments have created an environment where telemedicine is more accessible and capable than ever before, particularly in the field of ophthalmology. Ever-increasing global demand for ophthalmic services due to population growth and ageing together with insufficient supply of ophthalmologists requires new models of healthcare provision integrating telemedicine to meet present day challenges, with the recent COVID-19 pandemic providing the catalyst for the widespread adoption and acceptance of teleophthalmology. In this review we discuss the history, present and future application of telemedicine within the field of ophthalmology, and specifically retinal disease. We consider the strengths and limitations of teleophthalmology, its role in screening, community and hospital management of retinal disease, patient and clinician attitudes, and barriers to its adoption.
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Affiliation(s)
- Jonathan Than
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, UK
| | - Peng Y Sim
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, UK
| | - Danson Muttuvelu
- Department of Ophthalmology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- MitØje ApS/Danske Speciallaeger Aps, Aarhus, Denmark
| | - Daniel Ferraz
- D'Or Institute for Research and Education (IDOR), São Paulo, Brazil
- Institute of Ophthalmology, University College London, London, UK
| | - Victor Koh
- Department of Ophthalmology, National University Hospital, Singapore, Singapore
| | - Swan Kang
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, UK
| | - Josef Huemer
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, UK.
- Department of Ophthalmology and Optometry, Kepler University Hospital, Johannes Kepler University, Linz, Austria.
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3
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Akapo AO, Schultz C, Coelho D, Muffly TM. American Indian and Alaskan Native Access to Obstetrics and Gynecology Subspecialists: Findings From a National Mystery Caller Study in the United States. Cureus 2023; 15:e51403. [PMID: 38292990 PMCID: PMC10826858 DOI: 10.7759/cureus.51403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2023] [Indexed: 02/01/2024] Open
Abstract
Background A significant disparity exists for American Indian and Alaska Native populations in accessing obstetric and gynecology (OBGYN) subspecialty care, as nearly 43% of individuals do not reside in areas where the Indian Health Service (IHS) provides care. Geographical separation from IHS facilities exacerbates healthcare disparities, particularly regarding access to specialized services. This study aims to create a map illustrating the average driving time from an IHS clinic to OBGYN subspecialists (e.g., gynecologic oncology, maternal-fetal medicine, family planning, urogynecology, pediatric and adolescent gynecology, and reproductive endocrinology and infertility [REI]) and determine the average wait time for appointments with these specialists. Study design A cross-sectional and mystery caller study was conducted using hospital-level data from the IHS and data on women from the 2010 United States Census provided by the US Census Bureau. All US OBGYN subspecialists were identified and mapped. The local distribution of clinics near IHS hospitals was determined, and the nearest OBGYN subspecialist was mapped to IHS hospitals providing women's care services. Thirty-seven OBGYN subspecialists closest to IHS hospitals were contacted to calculate the mean wait time for subspecialty care appointments. Results The median driving time to the closest gynecologic oncology, maternal-fetal medicine, family planning, urogynecology, pediatric and adolescent gynecology, and reproductive endocrinology and infertility OBGYN subspecialist was 214 minutes (interquartile range [IQR] 107-290). The longest drive to see a subspecialist for urogynecology services was over 240 minutes. From the 2010 US Census, we identified 583,574 American Indian and Alaska Native (AI/AN) pediatric, adolescent, and women within a 60-minute drive of an IHS hospital. The mean wait time for a new patient appointment was 13.6 business days (SD ± 2). Conclusions Geographical disparities significantly impact the ability of American Indian and Alaska Native populations to access OBGYN subspecialty care. There was no difference in wait times compared to the national average, though there were significantly longer drive times.
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Affiliation(s)
- Adeola O Akapo
- Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Claire Schultz
- Obstetrics and Gynecology, Denver Health and Hospital Authority, Denver, USA
| | - Diego Coelho
- Biostatistics and Epidemiology, Coelho Services, Florianópolis, BRA
| | - Tyler M Muffly
- Obstetrics and Gynecology, Denver Health and Hospital Authority, Denver, USA
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4
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Miller AM, Gill MK. A Review of the Prevalence of Ophthalmologic Diseases in Native American Populations. Am J Ophthalmol 2023; 254:54-61. [PMID: 37336384 DOI: 10.1016/j.ajo.2023.06.010] [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: 01/13/2023] [Revised: 06/08/2023] [Accepted: 06/10/2023] [Indexed: 06/21/2023]
Abstract
PURPOSE Compared with the general population in North America, Native American/American Indian and Alaska Native (AI/AN) populations experience a disparate prevalence of eye diseases. Visual impairment is a barrier to communication, interferes with academic and social success, and decreases overall quality of life. The prevalence of ocular pathology could serve as an indicator of health and social disparities. Therefore, the objective of this research was to perform a thorough review comparing the prevalence of common ophthalmological pathologies between AI/AN and non-AI/AN individuals in North America. DESIGN Retrospective, cross-sectional study. METHODS A total of 57 articles were retrieved and reviewed, and 14 met the criteria outlined for inclusion. These articles were retrieved from PubMed, MEDLINE, and ISI Web of Knowledge. Only studies that were peer reviewed in the last 25 years and reported on the prevalence of eye diseases in AI/AN compared with a non-AI/AN population met criteria. RESULTS Rates of retinopathy, cataracts, visual impairment, and blindness were clearly higher for AI/AN compared with non-AI/AN counterparts. Although rates of macular degeneration and glaucoma were similar between AI/AN and non-AI/AN populations, the treatment rates were lower and associated with poorer outcomes in AI/AN individuals. CONCLUSIONS There are considerable inequities in the prevalence and treatment rates of ophthalmologic conditions in AI/AN individuals. A likely explanation is the barrier of lack of access to adequate health and eye care. Because of substantial underinsurance and geographic variability, attention needs to be brought to expanding eye care access to AI/AN communities. The results are subject to the availability of appropriate technology, health literacy, and language.
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Affiliation(s)
- Alyssa M Miller
- From the Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (A.M.M., M.K.G.)
| | - Manjot K Gill
- From the Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (A.M.M., M.K.G.)..
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5
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Chew EY. The Clinical Significance and Implications of Developing Diabetic Retinopathy During the 5 Years Following the Diagnosis of Type 1 Diabetes. Diabetes Care 2023; 46:678-679. [PMID: 36952611 PMCID: PMC10090904 DOI: 10.2337/dci22-0062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Affiliation(s)
- Emily Y. Chew
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD
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6
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Moecke DP, Holyk T, Beckett M, Chopra S, Petlitsyna P, Girt M, Kirkham A, Kamurasi I, Turner J, Sneddon D, Friesen M, McDonald I, Denson-Camp N, Crosbie S, Camp PG. Scoping review of telehealth use by Indigenous populations from Australia, Canada, New Zealand, and the United States. J Telemed Telecare 2023:1357633X231158835. [PMID: 36911983 DOI: 10.1177/1357633x231158835] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
INTRODUCTION Telehealth has the potential to address health disparities experienced by Indigenous people, especially in remote areas. This scoping review aims to map and characterize the existing evidence on telehealth use by Indigenous people and explore the key concepts for effective use, cultural safety, and building therapeutic relationships. METHODS A search for published and gray literature, written in English, and published between 2000 and 2022 was completed in 17 electronic databases. Two reviewers independently screened retrieved records for eligibility. For included articles, data were extracted, categorized, and analyzed. Synthesis of findings was performed narratively. RESULTS A total of 321 studies were included. The most popular type of telehealth used was mHealth (44%), and the most common health focuses of the telehealth interventions were mental health (26%) and diabetes/diabetic retinopathy (13%). Frequently described barriers to effective telehealth use included concerns about privacy/confidentiality and limited internet availability; meanwhile, telehealth-usage facilitators included cultural relevance and community engagement. Although working in collaboration with Indigenous communities was the most frequently reported way to achieve cultural safety, 40% of the studies did not report Indigenous involvement. Finally, difficulty to establish trusting therapeutic relationships was a major concern raised about telehealth, and evidence suggests that having the first visit-in-person is a potential way to address this issue. CONCLUSION This comprehensive review identified critical factors to guide the development of culturally-informed telehealth services to meet the needs of Indigenous people and to achieve equitable access and positive health outcomes.
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Affiliation(s)
- Débora Petry Moecke
- University of British Columbia (UBC), Vancouver, Canada.,Faculty of Medicine, 8166University of British Columbia, Vancouver, Canada
| | - Travis Holyk
- Carrier Sekani Family Services, Prince George, Canada
| | - Madelaine Beckett
- University of British Columbia (UBC), Vancouver, Canada.,Faculty of Medicine, 8166University of British Columbia, Vancouver, Canada
| | - Sunaina Chopra
- University of British Columbia (UBC), Vancouver, Canada.,Faculty of Medicine, 8166University of British Columbia, Vancouver, Canada
| | | | - Mirha Girt
- 1974Faculty of Medicine, University of Queensland, Brisbane, Australia
| | | | - Ivan Kamurasi
- University of British Columbia (UBC), Vancouver, Canada.,Faculty of Medicine, 8166University of British Columbia, Vancouver, Canada
| | - Justin Turner
- University of British Columbia (UBC), Vancouver, Canada.,Faculty of Medicine, 8166University of British Columbia, Vancouver, Canada
| | - Donovan Sneddon
- University of British Columbia (UBC), Vancouver, Canada.,Faculty of Medicine, 8166University of British Columbia, Vancouver, Canada
| | | | - Ian McDonald
- University of British Columbia (UBC), Vancouver, Canada
| | | | | | - Pat G Camp
- University of British Columbia (UBC), Vancouver, Canada.,Faculty of Medicine, 8166University of British Columbia, Vancouver, Canada
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7
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Fonda SJ, Bursell SE, Lewis DG, Clary D, Shahon D, Cavallerano J. Incidence and Progression of Diabetic Retinopathy in American Indian and Alaska Native Individuals Served by the Indian Health Service, 2015-2019. JAMA Ophthalmol 2023; 141:366-375. [PMID: 36892822 PMCID: PMC9999279 DOI: 10.1001/jamaophthalmol.2023.0167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
Importance Estimates of diabetic retinopathy (DR) incidence and progression in American Indian and Alaska Native individuals are based on data from before 1992 and may not be informative for strategizing resources and practice patterns. Objective To examine incidence and progression of DR in American Indian and Alaska Native individuals. Design, Setting, and Participants This was a retrospective cohort study conducted from January 1, 2015, to December 31, 2019, and included adults with diabetes and no evidence of DR or mild nonproliferative DR (NPDR) in 2015 who were reexamined at least 1 time during the 2016 to 2019 period. The study setting was the Indian Health Service (IHS) teleophthalmology program for diabetic eye disease. Exposure Development of new DR or worsening of mild NPDR in American Indian and Alaska Native individuals with diabetes. Main Outcomes and Measures Outcomes were any increase in DR, 2 or more (2+) step increases, and overall change in DR severity. Patients were evaluated with nonmydriatic ultra-widefield imaging (UWFI) or nonmydriatic fundus photography (NMFP). Standard risk factors were included. Results The total cohort of 8374 individuals had a mean (SD) age of 53.2 (12.2) years and a mean (SD) hemoglobin A1c level of 8.3% (2.2%) in 2015, and 4775 were female (57.0%). Of patients with no DR in 2015, 18.0% (1280 of 7097) had mild NPDR or worse in 2016 to 2019, and 0.1% (10 of 7097) had PDR. The incidence rate from no DR to any DR was 69.6 cases per 1000 person-years at risk. A total of 6.2% of participants (441 of 7097) progressed from no DR to moderate NPDR or worse (ie, 2+ step increase; 24.0 cases per 1000 person-years at risk). Of patients with mild NPDR in 2015, 27.2% (347 of 1277) progressed to moderate NPDR or worse in 2016 to 2019, and 2.3% (30 of 1277) progressed to severe NPDR or worse (ie, 2+ step progression). Incidence and progression were associated with expected risk factors and evaluation with UWFI. Conclusions and Relevance In this cohort study, the estimates of DR incidence and progression were lower than those previously reported for American Indian and Alaska Native individuals. The results suggest extending the time between DR re-evaluations for certain patients in this population, if follow-up compliance and visual acuity outcomes are not jeopardized.
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Affiliation(s)
| | | | | | - Dawn Clary
- Phoenix Indian Medical Center, Phoenix, Arizona
| | - Dara Shahon
- Phoenix Indian Medical Center, Phoenix, Arizona
| | - Jerry Cavallerano
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts.,Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
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8
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Rachitskaya A. Use of Teleophthalmology to Evaluate the Incidence and Progression of Diabetic Retinopathy. JAMA Ophthalmol 2023; 141:376-377. [PMID: 36892828 DOI: 10.1001/jamaophthalmol.2023.0321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
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9
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Jain R, Tobey M. The Indian Health Service can meet its goals for hepatitis C virus treatment through telehealth expansion. J Rural Health 2023; 39:355-357. [PMID: 36210510 DOI: 10.1111/jrh.12718] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Radhika Jain
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Matthew Tobey
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Ricur G, Reyes J, Alfonso E, Marino RG. Surfing the COVID-19 Tsunami with Teleophthalmology: the Advent of New Models of Eye Care. CURRENT OPHTHALMOLOGY REPORTS 2023; 11:1-12. [PMID: 36743397 PMCID: PMC9883823 DOI: 10.1007/s40135-023-00308-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2023] [Indexed: 01/30/2023]
Abstract
Purpose of Review In this article, we reviewed the impact resulting from the COVID-19 pandemic on the traditional model of care in ophthalmology. Recent Findings Though virtual eye care has been present for more than 20 years, the COVID-19 pandemic has established a precedent to seriously consider its role in the evolving paradigm of vision and eye care. New hybrid models of care have enhanced or replaced traditional synchronous and asynchronous visits. The increased use of smart phoneography and mobile applications enhanced the remote examination of patients. Use of e-learning became a mainstream tool to continue accessing education and training. Summary Teleophthalmology has demonstrated its value for screening, examining, diagnosing, monitoring treatment, and increasing access to education. However, much of the progress made following the COVID-19 pandemic is at risk of being lost as society pushes to reestablish normalcy. Further studies during the new norm are required to prove a more permanent role for virtual eye care.
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Affiliation(s)
- Giselle Ricur
- Bascom Palmer Eye Institute, University of Miami, 900 NW 17Th St., Miami, FL 33136 USA
| | - Joshua Reyes
- Bascom Palmer Eye Institute, University of Miami, 900 NW 17Th St., Miami, FL 33136 USA
| | - Eduardo Alfonso
- Bascom Palmer Eye Institute, University of Miami, 900 NW 17Th St., Miami, FL 33136 USA
| | - Raul Guillermo Marino
- Facultad de Ciencias Exactas Y Naturales, Universidad Nacional de Cuyo, Mendoza, Argentina
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Fonda SJ, Bursell SE, Lewis DG, Clary D, Shahon D, Silva PS. Prevalence of Diabetic Eye Diseases in American Indians and Alaska Natives (AI/AN) as Identified by the Indian Health Service's National Teleophthalmology Program Using Ultrawide Field Imaging (UWFI). Ophthalmic Epidemiol 2022; 29:672-680. [PMID: 34726132 DOI: 10.1080/09286586.2021.1996611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 09/16/2021] [Accepted: 10/15/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Estimates of diabetic eye disease in American Indian and Alaska Natives (AI/AN) vary over time, region, and methods. This article reports recent prevalence of diabetic retinopathy (DR) and diabetic macular edema (DME) in AI/AN served by the Indian Health Services' (IHS) teleophthalmology program, as identified using ultrawide field imaging (UWFI). METHODS This was a retrospective analysis of 2016-2019 clinical data (n = 53,900). UWF images were acquired by certified imagers using a validated protocol, and graded by licensed, certified optometrists supervised by an ophthalmologist. Graders evaluated the extent/severity of retinal lesions in comparison to standard photographs. DR lesions predominantly in any peripheral field were considered "predominantly peripheral lesions" (PPL). The analyses calculated prevalence of any DR, any DME, DR and DME severity, sight-threatening disease, and PPL. RESULTS Patients averaged 56 years of age with a 68 mmol/mol A1c and 55% had had diabetes for 5+ years. Prevalence of any DR, any DME, and sight-threatening disease was 28.6%, 3.0%, and 3.0%. In patients with mild nonproliferative DR, PPL was seen in 25.3%. PPL suggested a more severe level of DR in 8.7% of patients. DR increased with age. DME decreased with age. Males and patients in the Nashville IHS area had more diabetic eye disease. CONCLUSION AI/AN have a high burden of diabetes and its complications. The IHS is resource-constrained, making accurate disease estimates necessary for resource allocation and budget justifications to Congress. These data update the estimates of diabetic eye disease in Indian Country and suggest that UWFI identifies early DR.
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Affiliation(s)
| | - Sven-Erik Bursell
- Telehealth Research Institute, John A. Burns School of Medicine, University of Hawaii, Honolulu, USA
| | | | - Dawn Clary
- Indian Health Service-Joslin Vision Network, Phoenix Indian Medical Center, Phoenix, AZ, USA
| | - Dara Shahon
- Indian Health Service-Joslin Vision Network, Phoenix Indian Medical Center, Phoenix, AZ, USA
| | - Paolo S Silva
- Beetham Eye Institute, Joslin Diabetes Center, Boston, MA, USA
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
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12
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Przybek-Skrzypecka J, Szewczuk A, Kamińska A, Skrzypecki J, Pyziak-Skupień A, Szaflik JP. Effect of COVID-19 Lockdowns on Eye Emergency Department, Increasing Prevalence of Uveitis and Optic Neuritis in the COVID-19 Era. Healthcare (Basel) 2022; 10:healthcare10081422. [PMID: 36011079 PMCID: PMC9408570 DOI: 10.3390/healthcare10081422] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/25/2022] [Accepted: 07/27/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The COVID-19 pandemic led to the reorganization of the health care system. A decline in health- and life-saving procedures has been reported in various medical specialties. However, data on ophthalmic emergencies during lockdowns is limited. Methods: We conducted a retrospective, observational, case-control study of 2351 patients registered at the ophthalmic emergency department of a tertiary hospital in Poland during three national COVID-19 lockdowns (March/April 2020, November 2020, and March/April 2021) and corresponding months in 2019. Results: The total number of visits declined from a mean of 720/month in the non-COVID era to 304/month during COVID-19 lockdowns (p < 0.001). Ocular trauma incidence dropped significantly from 2019 (non-COVID months) to 2020/2021 (COVID group mean 201 vs. 97 patients monthly, respectively, p = 0.03). Of note, the percentage of foreign bodies removal was significantly higher during lockdowns than corresponding time in the non-COVID era. A downward trend for vitreous detachment and macular disorders cases was observed between COVID and non-COVID time. Uveitis and optic neuritis patients were seen more often during lockdowns (p < 0.001 and p = 0.0013, respectively). In contrast, the frequency of conjunctivitis and keratitis, potentially COVID-related problems, decreased significantly in COVID-19 time (mean 138 vs. 23 per month in non-COVID vs. COVID lockdowns, respectively, p < 0.001). Conclusions: The overall number of eye emergency visits declined during COVID-19 lockdowns. Conjunctivitis and keratitis rates dropped during the lockdowns. Interestingly, the frequency of immune-mediated ocular conditions (uveitis, optic neuritis) increased significantly which might be triggered by SARS-CoV2 infection.
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Affiliation(s)
- Joanna Przybek-Skrzypecka
- Department of Ophthalmology, The Medical University of Warsaw, 61 Żwirki i Wigury Street, 02-091 Warsaw, Poland; (A.K.); (J.P.S.)
- SPKSO Ophthalmic University Hospital, 24/26 Marszałkowska Street, 00-576 Warsaw, Poland; (A.S.); (J.S.)
- Correspondence:
| | - Alina Szewczuk
- SPKSO Ophthalmic University Hospital, 24/26 Marszałkowska Street, 00-576 Warsaw, Poland; (A.S.); (J.S.)
| | - Anna Kamińska
- Department of Ophthalmology, The Medical University of Warsaw, 61 Żwirki i Wigury Street, 02-091 Warsaw, Poland; (A.K.); (J.P.S.)
- SPKSO Ophthalmic University Hospital, 24/26 Marszałkowska Street, 00-576 Warsaw, Poland; (A.S.); (J.S.)
| | - Janusz Skrzypecki
- SPKSO Ophthalmic University Hospital, 24/26 Marszałkowska Street, 00-576 Warsaw, Poland; (A.S.); (J.S.)
- Department of Experimental Physiology and Pathophysiology, The Medical University of Warsaw, 3C Pawińskiego Street, 02-106 Warsaw, Poland
| | - Aleksandra Pyziak-Skupień
- Department of Children’s Diabetology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 16 Medyków Street, 40-752 Katowice, Poland;
| | - Jacek Paweł Szaflik
- Department of Ophthalmology, The Medical University of Warsaw, 61 Żwirki i Wigury Street, 02-091 Warsaw, Poland; (A.K.); (J.P.S.)
- SPKSO Ophthalmic University Hospital, 24/26 Marszałkowska Street, 00-576 Warsaw, Poland; (A.S.); (J.S.)
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13
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Kruse G, Lopez-Carmen VA, Jensen A, Hardie L, Sequist TD. The Indian Health Service and American Indian/Alaska Native Health Outcomes. Annu Rev Public Health 2022; 43:559-576. [PMID: 35081315 DOI: 10.1146/annurev-publhealth-052620-103633] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The Indian Health Service (IHS) has made huge strides in narrowing health disparities between American Indian and Alaska Native (AI/AN) populations and other racial and ethnic groups. Yet, health disparities experienced by AI/AN people persist, with deep historical roots combined with present-day challenges. Here we review the history of the IHS from colonization to the present-day system, highlight persistent disparities in AI/AN health and health care, and discuss six key present-day challenges: inadequate funding, limited human resources, challenges associated with transitioning services from federal to Tribal control through contracting and compacting, evolving federal and state programs, the need for culturally sensitive services, and the promise and challenges of health technology.
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Affiliation(s)
- Gina Kruse
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA;
- Harvard Medical School, Boston, Massachusetts, USA
| | | | - Anpotowin Jensen
- School of Engineering, Stanford University, Stanford, California, USA
| | - Lakotah Hardie
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA;
| | - Thomas D Sequist
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Quality and Patient Experience, Massachusetts General Brigham, Somerville, Massachusetts, USA
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Awan MA, Shaheen F, Mohsin F. Impact of COVID-19 lockdown on Retinal Surgeries. Pak J Med Sci 2021; 37:1808-1812. [PMID: 34912399 PMCID: PMC8613012 DOI: 10.12669/pjms.37.7.4291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 06/08/2021] [Accepted: 07/04/2021] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To determine the frequency and severity of surgical Vitreo-Retinal diseases during COVID-19 lockdown period (LP) and compare it with same period last year. METHODS Single hospital based retrospective Cohort Study. Data of the patients that underwent retinal surgeries during the COVID-19 LP i.e., 23-03-2020 till 23-06-2020 and same period last year i.e., 23-03-2019 till 23-06-2019 was analyzed. RESULTS One hundred thirty-six eyes of 105 patients were included. Among these eyes, 48 (35.3%) were operated during the COVID-19 LP while 88 (64.7%) were operated during the same time last year. A decline of 45.5% (p=0.023) was observed in the frequency of surgeries during the LP. Mean age of patients during the LP was 43.2 ± 20.3 years compared to 48.4 ± 17.9 years last year. There was reduction in the surgeries for Diabetic Tractional Retinal Detachment (11.4% vs 4.2% during LP, p=0.166), Vitreous hemorrhage (10.2 % vs 8.3% during LP, p=0.04), Full thickness macular hole (3.4% vs 0% during LP) and Epiretinal membrane (12.5% vs 0% during LP). While Rhegmatogenous retinal detachment (27.3% vs 58.3% during LP, p<0.001) among other disorders had a higher proportion during the LP. CONCLUSION The decline in the frequency of retinal surgeries during the LP is indicative of complex pathologies presenting later with more advanced disease. However, earlier presentation and an increase trend in surgeries for RRD during the LP shows the positive impact of free time on the health concerns of our population.
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Affiliation(s)
- Muhammad Amer Awan
- Dr. Muhammad Amer Awan, Department of Ophthalmology, Shifa International Hospital, Islamabad, Pakistan
| | - Fiza Shaheen
- Dr. Fiza Shaheen, Department of Ophthalmology, Shifa International Hospital, Islamabad, Pakistan
| | - Fatima Mohsin
- Dr. Fatima Mohsin. Department of Ophthalmology, Shifa International Hospital, Islamabad, Pakistan
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15
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Fort PE, Rajendiran TM, Soni T, Byun J, Shan Y, Looker HC, Nelson RG, Kretzler M, Michailidis G, Roger JE, Gardner TW, Abcouwer SF, Pennathur S, Afshinnia F. Diminished retinal complex lipid synthesis and impaired fatty acid β-oxidation associated with human diabetic retinopathy. JCI Insight 2021; 6:e152109. [PMID: 34437304 PMCID: PMC8525591 DOI: 10.1172/jci.insight.152109] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/25/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND This study systematically investigated circulating and retinal tissue lipid determinants of human diabetic retinopathy (DR) to identify underlying lipid alterations associated with severity of DR. METHODS Retinal tissues were retrieved from postmortem human eyes, including 19 individuals without diabetes, 20 with diabetes but without DR, and 20 with diabetes and DR, for lipidomic study. In a parallel study, serum samples from 28 American Indians with type 2 diabetes from the Gila River Indian Community, including 12 without DR, 7 with mild nonproliferative DR (NPDR), and 9 with moderate NPDR, were selected. A mass-spectrometry–based lipidomic platform was used to measure serum and tissue lipids. RESULTS In the postmortem retinas, we found a graded decrease of long-chain acylcarnitines and longer-chain fatty acid ester of hydroxyl fatty acids, diacylglycerols, triacylglycerols, phosphatidylcholines, and ceramide(NS) in central retina from individuals with no diabetes to those with diabetes with DR. The American Indians’ sera also exhibited a graded decrease in circulating long-chain acylcarnitines and a graded increase in the intermediate-length saturated and monounsaturated triacylglycerols from no DR to moderate NPDR. CONCLUSION These findings suggest diminished synthesis of complex lipids and impaired mitochondrial β-oxidation of fatty acids in retinal DR, with parallel changes in circulating lipids. TRIAL REGISTRATION ClinicalTrials.gov NCT00340678. FUNDING This work was supported by NIH grants R24 DK082841, K08DK106523, R03DK121941, P30DK089503, P30DK081943, P30DK020572, P30 EY007003; The Thomas Beatson Foundation; and JDRF Center for Excellence (5-COE-2019-861-S-B).
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Affiliation(s)
- Patrice E Fort
- Department of Ophthalmology and Visual Sciences.,Department of Molecular and Integrative Physiology
| | | | | | - Jaeman Byun
- Department of Internal Medicine-Nephrology, University of Michigan, Ann Arbor, Michigan, USA
| | - Yang Shan
- Department of Ophthalmology and Visual Sciences
| | - Helen C Looker
- Chronic Kidney Disease Section, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), Phoenix, Arizona, USA
| | - Robert G Nelson
- Chronic Kidney Disease Section, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), Phoenix, Arizona, USA
| | - Matthias Kretzler
- Department of Internal Medicine-Nephrology, University of Michigan, Ann Arbor, Michigan, USA
| | - George Michailidis
- Department of Statistics and the Informatics Institute, University of Florida, Gainesville, Florida, USA
| | - Jerome E Roger
- Paris-Saclay Institute of Neuroscience, CERTO-Retina France, CNRS, Université Paris-Saclay, Orsay, France
| | - Thomas W Gardner
- Department of Ophthalmology and Visual Sciences.,Department of Molecular and Integrative Physiology.,Department of Internal Medicine-Metabolism, Endocrinology and Diabetes, and
| | | | - Subramaniam Pennathur
- Department of Molecular and Integrative Physiology.,Department of Internal Medicine-Nephrology, University of Michigan, Ann Arbor, Michigan, USA.,Michigan Regional Comprehensive Metabolomics Resource Core, University of Michigan, Ann Arbor, Michigan, USA
| | - Farsad Afshinnia
- Department of Internal Medicine-Nephrology, University of Michigan, Ann Arbor, Michigan, USA
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16
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Burn H, Hamm L, Black J, Burnett A, Harwood M, Burton MJ, Evans JR, Ramke J. Eye care delivery models to improve access to eye care for Indigenous peoples in high-income countries: a scoping review. BMJ Glob Health 2021; 6:bmjgh-2020-004484. [PMID: 33762252 PMCID: PMC7993359 DOI: 10.1136/bmjgh-2020-004484] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/28/2020] [Accepted: 01/20/2021] [Indexed: 12/27/2022] Open
Abstract
Purpose Globally, there are ~370 million Indigenous peoples. Indigenous peoples typically experience worse health compared with non-Indigenous people, including higher rates of avoidable vision impairment. Much of this gap in eye health can be attributed to barriers that impede access to eye care services. We conducted a scoping review to identify and summarise service delivery models designed to improve access to eye care for Indigenous peoples in high-income countries. Methods Searches were conducted on MEDLINE, Embase and Global Health in January 2019 and updated in July 2020. All study designs were eligible if they described a model of eye care service delivery aimed at populations with over 50% Indigenous peoples. Two reviewers independently screened titles, abstracts and full-text articles and completed data charting. We extracted data on publication details, study context, service delivery interventions, outcomes and evaluations, engagement with Indigenous peoples and access dimensions targeted. We summarised findings descriptively following thematic analysis. Results We screened 2604 abstracts and 67 studies fulfilled our eligibility criteria. Studies were focused on Indigenous peoples in Australia (n=45), USA (n=11), Canada (n=7), New Zealand (n=2), Taiwan (n=1) and Greenland (n=1). The main disease focus was diabetic retinopathy (n=30, 45%), followed by ‘all eye care’ (n=16, 24%). Most studies focused on targeted interventions to increase availability of services. Fewer than one-third of studies reported involving Indigenous communities when designing the service. 41 studies reflected on whether the model improved access, but none undertook rigorous evaluation or quantitative assessment. Conclusions The geographical and clinical scope of service delivery models to improve access to eye care for Indigenous peoples in high-income countries is narrow, with most studies focused on Australia and services for diabetic retinopathy. More and better engagement with Indigenous communities is required to design and implement accessible eye care services.
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Affiliation(s)
- Helen Burn
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Lisa Hamm
- School of Optometry and Vision Science, Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Joanna Black
- School of Optometry and Vision Science, Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Anthea Burnett
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Matire Harwood
- General Practice and Primary Healthcare, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Matthew J Burton
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK.,Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Jennifer R Evans
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Jacqueline Ramke
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK.,School of Optometry and Vision Science, Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand
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17
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Pieczynski J, Kuklo P, Grzybowski A. The Role of Telemedicine, In-Home Testing and Artificial Intelligence to Alleviate an Increasingly Burdened Healthcare System: Diabetic Retinopathy. Ophthalmol Ther 2021; 10:445-464. [PMID: 34156632 PMCID: PMC8217784 DOI: 10.1007/s40123-021-00353-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 05/15/2021] [Indexed: 01/30/2023] Open
Abstract
In the presence of the ever-increasing incidence of diabetes mellitus (DM), the prevalence of diabetic eye disease (DED) is also growing. Despite many improvements in diabetic care, DM remains a leading cause of visual impairment in working-age patients. So far, prevention has been the best way to protect vision. The sooner we diagnose DED, the more effective the treatment is. Thus, diabetic retinopathy (DR) screening, especially with imaging techniques, is a method of choice for vision protection. To alleviate the burden of diabetic patients who need ophthalmic care, telemedicine and in-home testing are used, supported by artificial intelligence (AI) algorithms. This is why we decided to evaluate current image teleophthalmology methods used for DR screening. We searched the PubMed platform for papers published over the last 5 years (2015–2020) using the following key words: telemedicine in diabetic retinopathy screening, diabetic retinopathy screening, automated diabetic retinopathy screening, artificial intelligence in diabetic retinopathy screening, smartphone diabetic retinopathy testing. We have included 118 original articles meeting the above criteria, discussing imaging diabetic retinopathy screening methods. We have found that fundus cameras, stable or mobile, are most commonly used for retinal photography, with portable fundus cameras also relatively common. Other possibilities involve the use of ultra-wide-field (UWF) imaging and even optical coherence tomography (OCT) devices for DR screening. Also, the role of smartphones is increasingly recognized in the field. Retinal fundus images are assessed by humans instantly or remotely, while AI algorithms seem to be useful tools facilitating retinal image assessment. The common use of smartphones and availability of relatively cheap, easy-to-use adapters for retinal photographs augmented by AI algorithms make it possible for eye fundus photographs to be taken by non-specialists and in non-medical setting. This opens the way for in-home testing conducted on a much larger scale in the future. In conclusion, based on current DR screening techniques, we can suggest that the future practice of eye care specialists will be widely supported by AI algorithms, and this way will be more effective.
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Affiliation(s)
- Janusz Pieczynski
- Chair of Ophthalmology, University of Warmia and Mazury, Zolnierska 18, 10-561, Olsztyn, Poland. .,The Voivodal Specialistic Hospital in Olsztyn, Olsztyn, Poland.
| | - Patrycja Kuklo
- Chair of Ophthalmology, University of Warmia and Mazury, Zolnierska 18, 10-561, Olsztyn, Poland.,The Voivodal Specialistic Hospital in Olsztyn, Olsztyn, Poland
| | - Andrzej Grzybowski
- Chair of Ophthalmology, University of Warmia and Mazury, Zolnierska 18, 10-561, Olsztyn, Poland.,Institute for Research in Ophthalmology, Poznan, Poland, Gorczyczewskiego 2/3, 61-553, Poznan, Poland
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18
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Sommer AC, Blumenthal EZ. Telemedicine in ophthalmology in view of the emerging COVID-19 outbreak. Graefes Arch Clin Exp Ophthalmol 2020; 258:2341-2352. [PMID: 32813110 PMCID: PMC7436071 DOI: 10.1007/s00417-020-04879-2] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/23/2020] [Accepted: 07/30/2020] [Indexed: 01/08/2023] Open
Abstract
Purpose Technological advances in recent years have resulted in the development and implementation of various modalities and techniques enabling medical professionals to remotely diagnose and treat numerous medical conditions in diverse medical fields, including ophthalmology. Patients who require prolonged isolation until recovery, such as those who suffer from COVID-19, present multiple therapeutic dilemmas to their caregivers. Therefore, utilizing remote care in the daily workflow would be a valuable tool for the diagnosis and treatment of acute and chronic ocular conditions in this challenging clinical setting. Our aim is to review the latest technological and methodical advances in teleophthalmology and highlight their implementation in screening and managing various ocular conditions. We present them as well as potential diagnostic and treatment applications in view of the recent SARS-CoV-2 virus outbreak. Methods A computerized search from January 2017 up to March 2020 of the online electronic database PubMed was performed, using the following search strings: “telemedicine,” “telehealth,” and “ophthalmology.” More generalized complementary contemporary research data regarding the COVID-19 pandemic was also obtained from the PubMed database. Results A total of 312 records, including COVID-19-focused studies, were initially identified. After exclusion of non-relevant, non-English, and duplicate studies, a total of 138 records were found eligible. Ninety records were included in the final qualitative analysis. Conclusion Teleophthalmology is an effective screening and management tool for a range of adult and pediatric acute and chronic ocular conditions. It is mostly utilized in screening of retinal conditions such as retinopathy of prematurity, diabetic retinopathy, and age-related macular degeneration; in diagnosing anterior segment condition; and in managing glaucoma. With improvements in image processing, and better integration of the patient’s medical record, teleophthalmology should become a more accepted modality, all the more so in circumstances where social distancing is inflicted upon us. ![]()
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Affiliation(s)
- Adir C Sommer
- Department of Ophthalmology, Rambam Health Care Campus, P.O.B 9602, 31096, Haifa, Israel
| | - Eytan Z Blumenthal
- Department of Ophthalmology, Rambam Health Care Campus, P.O.B 9602, 31096, Haifa, Israel. .,Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
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19
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Real-world vitreoretinal practice patterns during the 2020 COVID-19 pandemic: a nationwide, aggregated health record analysis. Curr Opin Ophthalmol 2020; 31:427-434. [PMID: 32740067 DOI: 10.1097/icu.0000000000000692] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE OF REVIEW The COVID-19 pandemic has posed an unprecedented challenge to the healthcare community. To reduce disease transmission, national regulatory agencies temporarily recommended curtailment of all nonurgent office visits and elective surgeries in March 2020, including vitreoretinal outpatient care in the USA. The effect of these guidelines on utilization of vitreoretinal care has not been explored to date. RECENT FINDINGS Retinal outpatient visits, new patient visits, intravitreal antivascular endothelial growth factor injections and in-office multimodal retinal imaging has seen a significant decline in utilization in the early phase of the pandemic. Intravitreal injections were performed at a comparatively higher rate than office visits. Utilization appeared to steadily increase in April 2020. Telemedicine visits, enabled by new national legislation for all areas of medicine, have been adopted to a modest degree by the retina community. SUMMARY In-office retinal care declined in response to the COVID-19 pandemic and national regulatory guidelines limiting nonurgent care. These trends in practice patterns and care utilization may be of interest to vitreoretinal providers and all ophthalmologists at large.
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20
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Scott BK, Miller GT, Fonda SJ, Yeaw RE, Gaudaen JC, Pavliscsak HH, Quinn MT, Pamplin JC. Advanced Digital Health Technologies for COVID-19 and Future Emergencies. Telemed J E Health 2020; 26:1226-1233. [PMID: 32456560 DOI: 10.1089/tmj.2020.0140] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background: Coronavirus disease 2019 (COVID-19) has led to a national health care emergency in the United States and exposed resource shortages, particularly of health care providers trained to provide critical or intensive care. This article describes how digital health technologies are being or could be used for COVID-19 mitigation. It then proposes the National Emergency Tele-Critical Care Network (NETCCN), which would combine digital health technologies to address this and future crises. Methods: Subject matter experts from the Society of Critical Care Medicine and the Telemedicine and Advanced Technology Research Center examined the peer-reviewed literature and science/technology news to see what digital health technologies have already been or could be implemented to (1) support patients while limiting COVID-19 transmission, (2) increase health care providers' capability and capacity, and (3) predict/prevent future outbreaks. Results: Major technologies identified included telemedicine and mobile care (for COVID-19 as well as routine care), tiered telementoring, telecritical care, robotics, and artificial intelligence for monitoring. Several of these could be assimilated to form an interoperable scalable NETCCN. NETCCN would assist health care providers, wherever they are located, by obtaining real-time patient and supplies data and disseminating critical care expertise. NETCCN capabilities should be maintained between disasters and regularly tested to ensure continual readiness. Conclusions: COVID-19 has demonstrated the impact of a large-scale health emergency on the existing infrastructures. Short term, an approach to meeting this challenge is to adopt existing digital health technologies. Long term, developing a NETCCN may ensure that the necessary ecosystem is available to respond to future emergencies.
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Affiliation(s)
- Benjamin K Scott
- Department of Anesthesiology, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Geoffrey T Miller
- Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, Fort Detrick, Maryland, USA.,School of Health Professions, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Stephanie J Fonda
- Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, Fort Detrick, Maryland, USA.,Estenda Solutions, Inc., Conshohocken, Pennsylvania, USA
| | - Ronald E Yeaw
- Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, Fort Detrick, Maryland, USA
| | - James C Gaudaen
- Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, Fort Detrick, Maryland, USA
| | - Holly H Pavliscsak
- Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, Fort Detrick, Maryland, USA
| | - Matthew T Quinn
- Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, Fort Detrick, Maryland, USA
| | - Jeremy C Pamplin
- Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, Fort Detrick, Maryland, USA.,Departments of Medicine, and Military and Emergency Medicine, Uniformed Services University, Bethesda, Maryland, USA
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