Implementation and evaluation of a low-cost telemedicine station in the remote Ecuadorian rainforest

Available Technologies, Applications and Benefits of Teleorthodontics. A Literature Review and Possible Applications during the COVID-19 Pandemic

Background: COVID-2019 spread rapidly throughout the world from China. This infection is highly contagiousness, has a high morbidity, and is capable of evolving into a potentially lethal form of interstitial pneumonia. Numerous countries shut-down various activities that were considered “not essential.” Dental treatment was in this category and, at the time of writing, only non-deferrable emergencies are still allowed in many countries. Therefore, follow-up visits of ongoing active therapies (e.g., orthodontic treatment) must be handled taking special precautions. This literature review aims at reducing in-office appointments by providing an overview of the technologies available and their reliability in the long-distance monitoring of patients, i.e., teledentistry. Methods: A literature review was made according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guidelines. Randomized clinical trials, cross sectional, observational, and case-control studies were evaluated with the Mixed Methods Appraisal Tool for quality assessment and study limitations. Results: A primary search found 80 articles, 69/80 were excluded as non-relevant on the basis of: the abstract, title, study design, bias, and/or lack of relevance. Twelve articles were included in the qualitative analysis. Conclusions: Teleorthodontics can manage most emergencies, reassuring and following patients remotely. The aim set by dental teleassistance was met as it reduced patients’ office visits whilst maintaining regular monitoring, without compromising the results. Although our preliminary findings should be further investigated to objectively evaluate the efficacy, cost-effectiveness, and long-term results, we are confident that teleassistance in orthodontics will have a role to play in the near future.

Implementation of a 24-Hour Teleradiology Service for Cruise Ships: A Pilot Study

OBJECTIVE. The purpose of this study was to introduce a 24-hour teleradiology service for cruise ships as a novel concept in maritime telemedicine. SUBJECTS AND METHODS. One cruise ship equipped with a mobile radiography unit and digital storage imaging plates was involved in this pilot study. Radiographs were transmitted via satellite internet to a tertiary hospital on shore for image interpretation by expert radiologists. Use of a virtual private network (VPN) enabled secure data transfer. Radiographs and patient data were automatically integrated into the PACS and radiology information system of the radiology department at the hospital. Images were analyzed by the staff radiologist at the hospital, and reports were immediately returned via e-mail through the VPN tunnel. RESULTS. Seventy-five radiographs of 47 patients were obtained on board within 2 months. All datasets were successfully transmitted. Most of the examinations (35 [≈ 75%]) were skeletal radiographs; the other 12 (≈ 25%) were chest radiographs. The turnaround time for the radiology reports was within 30 minutes in 43 cases (≈ 92%). In four cases (≈ 8%), delay was due to technical and organizational issues at the tertiary hospital. CONCLUSION. With the objective of supporting ship physicians with expert analyses of radiographs, a secure and stable method of image and radiology report transmission between an onboard hospital and a land-based radiology department was established.

Tele-Ultrasound in Resource-Limited Settings: A Systematic Review

Background: Telemedicine, or healthcare delivery from a distance, has evolved over the past 50 years and helped alter health care delivery to patients around the globe. Its integration into numerous domains has permitted high quality care that transcends obstacles of geographic distance, lack of access to health care providers, and cost. Ultrasound is an effective diagnostic tool and its application within telemedicine (“tele-ultrasound”) has advanced substantially in recent years, particularly in high-income settings. However, the utility of tele-ultrasound in resource-limited settings is less firmly established.

Objective: To determine whether remote tele-ultrasound is a feasible, accurate, and care-altering imaging tool in resource-limited settings.

Data Sources: PubMed, MEDLINE, and Embase.

Study Eligibility Criteria: Twelve original articles met the following eligibility criteria: full manuscript available, written in English, including a direct patient-care intervention, performed in a resource-limited setting, images sent to a remote expert reader for interpretation and feedback, contained objective data on the impact of tele-ultrasound.

Study Appraisal and Synthesis Methods: Abstracts were independently screened by two authors against inclusion criteria for full-text review. Any discrepancies were settled by a senior author. Data was extracted from each study using a modified Cochrane Consumers and Communication Review Group's data extraction template. Study bias was evaluated using the ROBINS-I tool.

Results: The study results reflect the diverse applications of tele-ultrasound in low-resource settings. Africa was the most common study location. The specialties of cardiology and obstetrics comprised most studies. Two studies primarily relied on smartphones for image recording and transmission. Real-time, rather than asynchronous, tele-ultrasound image interpretation occurred in five of the 12 studies. The most common outcome measures were image quality, telemedicine system requirements, diagnostic accuracy, and changes in clinical management.

Limitations: The studies included were of poor quality with a dearth of randomized control trials and with significant between study heterogeneity which resulted in incomplete data and made cross study comparison difficult.

Conclusions and Implications of Key Findings: Low-quality evidence suggests that ultrasound images acquired in resource-limited settings and transmitted using a telemedical platform to an expert interpreter are of satisfactory quality and value for clinical diagnosis and management.

Telemedicine across borders: a systematic review of factors that hinder or support implementation

PURPOSE

Innovative technologies to deliver health care across borders have attracted both evangelists and sceptics. Our aim was to systematically identify factors that hinder or support implementation of cross-border telemedicine services worldwide in the last two decades.

METHODS

Two reviewers independently searched ten databases including MEDLINE and EMBASE, in June 2011 including citations from 1990 onwards when at least an abstract was available in English. We also searched ELDIS and INTUTE databases and Internet search engines to identify grey literature. We included studies which (a) described the use of telemedicine to deliver cross-border healthcare and, or (b) described the factors that hinder or support implementation of cross-border telemedicine services. All study designs were included. Two reviewers independently assessed titles and abstracts of articles identified. Papers were allocated to one of four reviewers who extracted relevant data and validated it. We took a qualitative approach to the analysis, conducting a narrative synthesis of the evidence.

RESULTS

6026 records were identified of which 5806 were excluded following screening of titles and abstracts. We assessed 227 full text articles, excluding 133 because they were fatally flawed or did not meet the inclusion criteria, producing a final sample of 94. They involved 76 countries worldwide, most involving collaborations between high and low or middle income countries. Most described services delivering a combination of types of telemedicine but specialties most represented were telepathology, telesurgery, Emergency and trauma telemedicine and teleradiology. Most link health professionals, with only a few linking professionals directly to patients. A main driver for the development of cross-border telemedicine is the need to improve access to specialist services in low and middle income countries and in underserved rural areas in high income countries. Factors that hinder or support implementation clustered into four main themes: (1) legal factors; (2) sustainability factors; (3) cultural factors; and (4) contextual factors.

CONCLUSIONS

National telemedicine programmes may build infrastructure and change mindsets, laying the foundations for successful engagement in cross-border services. Regional networks can also help with sharing of expertise and innovative ways of overcoming barriers to the implementation of services. Strong team leadership, training, flexible and locally responsive services delivered at low cost, using simple technologies, and within a clear legal and regulatory framework, are all important factors for the successful implementation of cross-border telemedicine services.

Teleortodontia: ferramenta de auxílio à prática clínica e à educação continuada

INTRODUÇÃO: a Tecnologia da Informação (TI) está revolucionando os relacionamentos interpessoais. Esse novo contexto tornou possível exercer à distância as profissões da área da saúde, um conceito denominado telessaúde. A essência dessa área é a oferta, à distância, de serviços e informação sobre saúde. Nesse contexto, a Ortodontia como especialidade não pode ficar alheia a esses avanços. OBJETIVO: esse artigo se propôs a investigar - através de revisão não sistemática da literatura - quais dentre as tecnologias disponíveis são passíveis de ser utilizadas no desenvolvimento de serviços de teleortodontia, como ferramentas de auxílio à prática clínica e à educação continuada. O uso de tecnologias já acessíveis no mercado pode viabilizar os serviços de teleortodontia no país. Apesar desse artigo ter analisado as condições técnicas e as tecnologias relacionadas ao objeto de estudo, concentra-se no campo das questões éticas/morais, legais e econômicas do processo.

Teleradiology in an inaccessible area of northern India

Teleradiology can be used to provide health care to rural populations, especially where there is a scarcity of resources, including on-site radiologists. We have established a network link between a commercial teleradiology provider in Bangalore, south India and the Ramakrishna Mission Hospital (RKMH), located over 3000 km away in the north east of India. Image files were transferred to Bangalore via an ADSL connection using secure file transfer protocol. In the 12-month period beginning in August 2007, a total of 962 studies was sent to Bangalore from the RKMH. The average turnaround time for the report to reach the hospital once the images had been received in Bangalore was six hours for non-emergency cases. For emergency cases the turnaround time was consistently below 30 minutes. Because the RKMH was a charitable institution providing rural patients with free or low-cost treatment, no charge was made for the reporting. Our experience demonstrates that remote implementation of teleradiology is possible in rural India. The service has proved valuable for the remote hospital concerned.

Teleoncology: current and future applications for improving cancer care globally

Access to quality cancer care is often unavailable in low-income and middle-income countries, and also in rural or remote areas of high-income countries. Teleoncology-oncology applications of medical telecommunications, including pathology, radiology, and other related disciplines-has the potential to enhance access to and quality of clinical cancer care, and to improve education and training. Implementation of teleoncology in the developing world requires an approach tailored to priorities, resources, and needs. Teleoncology can best achieve its proposed goals through consistent and long-term application. We review teleoncology initiatives that have the potential to decrease cancer-care inequality between resource-poor and resource-rich institutions and offer guidelines for the development of teleoncology programmes in low-income and middle-income countries.