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Fernandez CC, Ruiz MG. Telesurgery and telementoring. Cir Esp 2024:S2173-5077(24)00061-9. [PMID: 38430960 DOI: 10.1016/j.cireng.2024.01.012] [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: 07/27/2023] [Accepted: 01/22/2024] [Indexed: 03/05/2024]
Abstract
Telemedicine has revolutionized the field of surgery, with telemonitoring and telesurgery being 2 of its most promising applications. Telesurgery and telemonitoring are revolutionary applications that have the potential to change the way surgical operations are performed. These applications can allow surgeons to perform operations, enable surgeons to perform operations by assisting or supervising others through mentoring from a different location (telementoring). Despite the potential benefits of telemedicine and telementoring, there are still challenges that must be overcome before they can be widely used in clinical practice. For example, latency in data transmission can be a problem in telemedicine, as even a small delay in data transmission can affect the accuracy of the operation. Additionally, a sophisticated and expensive technological infrastructure is required, which can limit their use in some clinical settings. Although we need to work on its development technologically, ethically and legally, it is a promising tool.
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Affiliation(s)
- Carmen Cagigas Fernandez
- Servicio Cirugía General Hospital Universitario Marques de Valdecilla, Santander, Spain; Grupo de Investigación e Innovación en Cirugía, IDIVAL, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
| | - Marcos Gómez Ruiz
- Servicio Cirugía General Hospital Universitario Marques de Valdecilla, Santander, Spain; Grupo de Investigación e Innovación en Cirugía, IDIVAL, Hospital Universitario Marqués de Valdecilla, Santander, Spain
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Magelssen MI, Hjorth-Hansen AK, Andersen GN, Graven T, Kleinau JO, Skjetne K, Løvstakken L, Dalen H, Mjølstad OC. Clinical Influence of Handheld Ultrasound, Supported by Automatic Quantification and Telemedicine, in Suspected Heart Failure. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:1137-1144. [PMID: 36804210 DOI: 10.1016/j.ultrasmedbio.2022.12.015] [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: 04/19/2022] [Revised: 11/18/2022] [Accepted: 12/22/2022] [Indexed: 05/11/2023]
Abstract
Early and correct heart failure (HF) diagnosis is essential to improvement of patient care. We aimed to evaluate the clinical influence of handheld ultrasound device (HUD) examinations by general practitioners (GPs) in patients with suspected HF with or without the use of automatic measurement of left ventricular (LV) ejection fraction (autoEF), mitral annular plane systolic excursion (autoMAPSE) and telemedical support. Five GPs with limited ultrasound experience examined 166 patients with suspected HF (median interquartile range = 70 (63-78) y; mean ± SD EF = 53 ± 10%). They first performed a clinical examination. Second, they added an examination with HUD, automatic quantification tools and, finally, telemedical support by an external cardiologist. At all stages, the GPs considered whether the patients had HF. The final diagnosis was made by one of five cardiologists using medical history and clinical evaluation including a standard echocardiography. Compared with the cardiologists' decision, the GPs correctly classified 54% by clinical evaluation. The proportion increased to 71% after adding HUDs, and to 74 % after telemedical evaluation. Net reclassification improvement was highest for HUD with telemedicine. There was no significant benefit of the automatic tools (p ≥ 0.58). Addition of HUD and telemedicine improved the GPs' diagnostic precision in suspected HF. Automatic LV quantification added no benefit. Refined algorithms and more training may be needed before inexperienced users benefit from automatic quantification of cardiac function by HUDs.
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Affiliation(s)
- Malgorzata Izabela Magelssen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway; Clinic of Cardiology, St. Olavs University Hospital, Trondheim, Norway.
| | - Anna Katarina Hjorth-Hansen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway; Department of Internal Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Garrett Newton Andersen
- Department of Internal Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Torbjørn Graven
- Department of Internal Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Jens Olaf Kleinau
- Department of Internal Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Kyrre Skjetne
- Department of Internal Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Lasse Løvstakken
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Håvard Dalen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway; Clinic of Cardiology, St. Olavs University Hospital, Trondheim, Norway; Department of Internal Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Ole Christian Mjølstad
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway; Clinic of Cardiology, St. Olavs University Hospital, Trondheim, Norway
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Accorsi TAD, Nemoto RP, Nunes JT, de Azevedo AFB, Moreira FT, Kohler KF, Lima KDA, Amaral BDR, Morbeck RA, Pedrotti CHS. Clinical Features and Management of Patients Assessed by Cardiology Teleconsultation in the Brazilian Region with the Highest Number of Isolated Cities. Arq Bras Cardiol 2023; 120:e20220467. [PMID: 37162075 PMCID: PMC10263392 DOI: 10.36660/abc.20220467] [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: 07/06/2022] [Revised: 01/23/2023] [Accepted: 02/15/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Cardiovascular diseases are the leading cause of adult mortality. Geographically remote and low-income Brazilian regions lack specialized consultations. The telemedicine management of this population by cardiologists is not fully known. OBJECTIVES To analyze cardiology teleconsultation in the Brazilian region with the highest number of isolated cities. METHODS From February 2020 to October 2021, patients from the North Region of Brazil evaluated by local general practitioners were referred for cardiological evaluation by telemedicine. Referral reasons, demographics, clinical history, physical examinations, tests, medications, and prescriptions pre- and post-telemedicine were analyzed (p<0.05 was considered statistically significant). RESULTS We analyzed 653 patients. The attendance rate was 85.7% (53.1% female, mean age: 54.2±6.5 years). The main reasons for referral were cardiovascular symptoms (58.1%) and risk factors among asymptomatic patients (13.3%). Only 12.6% had a diagnosed disease. Most patients had regular physical examinations and electrocardiograms. Few had recent complementary tests. The prescription of angiotensin receptor blockers (ARBs), calcium channel blockers and statins was significantly increased, while that of digoxin, noncardiac beta-blockers and acetylsalicylic acid (ASA) was decreased at the first teleconsultation. Most of the tests requested were of low complexity and cost: electrocardiogram (28.2%), chest X-ray (14%), echocardiogram (64.5%) and blood tests (71.8%). For 2.1% of patients, interventions were indicated, and 8% were discharged after the first consultation. CONCLUSION On-demand cardiology teleconsultation contributes to heart disease treatment optimization. Most patients were referred with syndromic diagnoses without previous complementary tests. The specialist workup requested was usually available locally and at a low cost but precluded early discharge. Local training could optimize the referral.
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Affiliation(s)
- Tarso Augusto Duenhas Accorsi
- Hospital Israelita Albert EinsteinSão PauloSPBrasilHospital Israelita Albert Einstein – Telemedicine, São Paulo, SP – Brasil
| | - Renato Paladino Nemoto
- Hospital Israelita Albert EinsteinSão PauloSPBrasilHospital Israelita Albert Einstein – Telemedicine, São Paulo, SP – Brasil
| | - Jairo Tavares Nunes
- Hospital Israelita Albert EinsteinSão PauloSPBrasilHospital Israelita Albert Einstein – Telemedicine, São Paulo, SP – Brasil
| | | | - Flavio Tocci Moreira
- Hospital Israelita Albert EinsteinSão PauloSPBrasilHospital Israelita Albert Einstein – Telemedicine, São Paulo, SP – Brasil
| | - Karen Francine Kohler
- Hospital Israelita Albert EinsteinSão PauloSPBrasilHospital Israelita Albert Einstein – Telemedicine, São Paulo, SP – Brasil
| | - Karine de Amicis Lima
- Hospital Israelita Albert EinsteinSão PauloSPBrasilHospital Israelita Albert Einstein – Telemedicine, São Paulo, SP – Brasil
| | - Bruna Dayanne Reges Amaral
- Hospital Israelita Albert EinsteinSão PauloSPBrasilHospital Israelita Albert Einstein – Telemedicine, São Paulo, SP – Brasil
| | - Renata Albaladejo Morbeck
- Hospital Israelita Albert EinsteinSão PauloSPBrasilHospital Israelita Albert Einstein – Telemedicine, São Paulo, SP – Brasil
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de Oliveira Figueiredo MJ, Cuesta A, Duncker D, Boveda S, Guerra F, Márquez MF. Use of instant messaging in electrophysiological clinical practice in Latin America: a LAHRS survey. Europace 2023; 25:59-64. [PMID: 35727727 PMCID: PMC10103556 DOI: 10.1093/europace/euac080] [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: 02/02/2022] [Accepted: 05/03/2022] [Indexed: 11/14/2022] Open
Abstract
AIMS Instant messaging (IM) platforms are a prominent component of telemedicine and a practical tool for sharing clinical data and counselling. Purpose of the survey was to inquire about the use of IM, the platforms used, frequency, recipients, and contents in Latin America region. METHODS AND RESULTS An online survey was sent to medical community via newsletter and social media channels. The survey consisted in 22 questions, in Spanish and Portuguese, collected on SurveyMonkey. A total of 125 responders from 13 Latin-American countries (79% male, mean age 46.1 ± 9.7 years) completed the survey. Most of the responders declared that they send (88.8%) and receive (97.6%) clinical data through IM apps. Most senders declare that they anonymize clinical data before sending (71.0 ± 38.3%), but that the data received is anonymized only in 51.4 ± 33.5%. The most common tests shared with other physicians were 12-lead electrocardiograms (99.2%), followed by Holter recordings (68.0%) and tracings from electrophysiological studies (63.2%). The majority (55.2%) said that are unaware of legal data protection rules in their countries. CONCLUSIONS IM apps are used by medical professionals worldwide to share and discuss clinical data and are preferred to many other methods of data sharing and are often used to share many different types of clinical data. They are perceived as a fast and easy way of communication, but medical professionals should be aware of the appropriate use of IM to prevent legal and privacy issues.
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Affiliation(s)
| | - Alejandro Cuesta
- Cardiology Department, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - David Duncker
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, 45 Avenue de Lombez, 31076 Toulouse, France
| | - Federico Guerra
- Department of Biomedical Sciences and Public Health, University Hospital "Umberto I-Lancisi-Salesi", Marche Polytechnic University, Ancona, Italy
| | - Manlio F Márquez
- Clinical Investigation Department, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
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Desai NR, Diamond EJ. Emerging Role of Remote Patient Monitoring in Pulmonary Care: Telemedicine to Smart Phone. Chest 2021; 159:477-478. [PMID: 33563433 PMCID: PMC10162851 DOI: 10.1016/j.chest.2020.10.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 10/05/2020] [Indexed: 11/28/2022] Open
Affiliation(s)
- Neeraj R Desai
- Chicago Chest Center, University of Illinois at Chicago, Chicago, IL; AMITA Health, University of Illinois at Chicago, Chicago, IL; Department of Medicine, Division of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois at Chicago, Chicago, IL.
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Alhajri N, Simsekler MCE, Alfalasi B, Alhashmi M, AlGhatrif M, Balalaa N, Al Ali M, Almaashari R, Al Memari S, Al Hosani F, Al Zaabi Y, Almazroui S, Alhashemi H, Baltatu OC. Physicians' Attitudes Toward Telemedicine Consultations During the COVID-19 Pandemic: Cross-sectional Study. JMIR Med Inform 2021; 9:e29251. [PMID: 34001497 PMCID: PMC8171285 DOI: 10.2196/29251] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/04/2021] [Accepted: 05/17/2021] [Indexed: 02/06/2023] Open
Abstract
Background To mitigate the effect of the COVID-19 pandemic, health care systems worldwide have implemented telemedicine technologies to respond to the growing need for health care services during these unprecedented times. In the United Arab Emirates, video and audio consultations have been implemented to deliver health services during the pandemic. Objective This study aimed to evaluate whether differences exist in physicians’ attitudes and perceptions of video and audio consultations when delivering telemedicine services during the COVID-19 pandemic. Methods This survey was conducted on a cohort of 880 physicians from outpatient facilities in Abu Dhabi, which delivered telemedicine services during the COVID-19 pandemic between November and December 2020. In total, 623 physicians responded (response rate=70.8%). The survey included a 5-point Likert scale to measure physician’s attitudes and perceptions of video and audio consultations with reference to the quality of the clinical consultation and the professional productivity. Descriptive statistics were used to describe physicians’ sociodemographic characteristics (age, sex, designation, clinical specialty, duration of practice, and previous experience with telemedicine) and telemedicine modality (video vs audio consultations). Regression models were used to assess the association between telemedicine modality and physicians’ characteristics with the perceived outcomes of the web-based consultation. Results Compared to audio consultations, video consultations were significantly associated with physicians’ confidence toward managing acute consultations (odds ratio [OR] 1.62, 95% CI 1.2-2.21; P=.002) and an increased ability to provide patient education during the web-based consultation (OR 2.21, 95% CI 1.04-4.33; P=.04). There was no significant difference in physicians’ confidence toward managing long-term and follow-up consultations through video or audio consultations (OR 1.35, 95% CI 0.88-2.08; P=.17). Video consultations were less likely to be associated with a reduced overall consultation time (OR 0.69, 95% CI 0.51-0.93; P=.02) and reduced time for patient note-taking compared to face-to-face visits (OR 0.48, 95% CI 0.36-0.65; P<.001). Previous experience with telemedicine was significantly associated with a lower perceived risk of misdiagnosis (OR 0.46, 95% CI 0.3-0.71; P<.001) and an enhanced physician-patient rapport (OR 2.49, 95% CI 1.26-4.9; P=.008). Conclusions These results indicate that video consultations should be adopted frequently in the new remote clinical consultations. Previous experience with telemedicine was associated with a 2-fold confidence in treating acute conditions, less than a half of the perceived risk of misdiagnosis, and an increased ability to provide patients with health education and enhance the physician-patient rapport. Additionally, these results show that audio consultations are equivalent to video consultations in providing remote follow-up care to patients with chronic conditions. These findings may be beneficial to policymakers of e-health programs in low- and middle-income countries, where audio consultations may significantly increase access to geographically remote health services.
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Affiliation(s)
- Noora Alhajri
- Khalifa University College of Medicine and Health Science, Abu Dhabi, United Arab Emirates
| | | | - Buthaina Alfalasi
- Department of Family Medicine, Zayed Military Hospital, Abu Dhabi, United Arab Emirates
| | - Mohamed Alhashmi
- Khalifa University College of Medicine and Health Science, Abu Dhabi, United Arab Emirates
| | - Majd AlGhatrif
- Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Nahed Balalaa
- Department of General Surgery, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Maryam Al Ali
- Ambulatory Health Services, Zafarana Clinic, Abu Dhabi Healthcare Company, Abu Dhabi, United Arab Emirates
| | - Raghda Almaashari
- Department of Dermatology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Shammah Al Memari
- Abu Dhabi Public Health Center, Department of Health, Abu Dhabi, United Arab Emirates
| | - Farida Al Hosani
- Abu Dhabi Public Health Center, Department of Health, Abu Dhabi, United Arab Emirates
| | - Yousif Al Zaabi
- Abu Dhabi Public Health Center, Department of Health, Abu Dhabi, United Arab Emirates
| | - Shereena Almazroui
- Abu Dhabi Public Health Center, Department of Health, Abu Dhabi, United Arab Emirates
| | | | - Ovidiu C Baltatu
- Khalifa University College of Medicine and Health Science, Abu Dhabi, United Arab Emirates
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A Construction Method of Lower Limb Rehabilitation Robot with Remote Control System. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11020867] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In response to the rehabilitation needs of stroke patients who are unable to benefit from conventional rehabilitation due to the COVID-19 epidemic, this paper designs a robot that combines on-site and telerehabilitation. The objective is to assist the patient in walking. We design the electromechanical system with a gantry mechanism, body-weight support system, information feedback system, and man-machine interactive control system. The proposed rehabilitation robot remote system is based on the client/server (C/S) network framework to realize the remote control of the robot state logic and the transmission of patient training data. Based on the proposed system, doctors can set or adjust the training modes and control the parameters of the robot and guide remote patient rehabilitation training through video communication. The robotic system can further store and manage the rehabilitation data of the patient during training. Experiments show the human-computer interaction system of the lower limb rehabilitation robot has good performance, can accurately recognize the information of human motion posture, and achieve the goal of actively the following motion. Experiments confirm the feasibility of the proposed design, the information management of stroke patients, and the efficiency of rehabilitation training. The proposed system can reduce the workload of the doctors in practical training.
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Affiliation(s)
- Jong-Yeup Kim
- Department of Biomedical Informatics, Konyang University, College of Medicine, Daejeon, Korea
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