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Kok MO, Terra T, Tweheyo R, van der Hoeven M, Ponce MC, van Furth MT, Rutebemberwa E. Using telehealth to support community health workers in Uganda during COVID-19: a mixed-method study. BMC Health Serv Res 2023; 23:284. [PMID: 36973681 PMCID: PMC10040915 DOI: 10.1186/s12913-023-09217-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 02/23/2023] [Indexed: 03/28/2023] Open
Abstract
Background At the onset of the COVID-19 pandemic, a local consortium in Uganda set up a telehealth approach that aimed to educate 3,500 Community Health Workers (CHW) in rural areas about COVID-19, help them identify, refer and care for potential COVID-19 cases, and support them in continuing their regular community health work. The aim of this study was to assess the functioning of the telehealth approach that was set up to support CHWs during the COVID-19 pandemic. Methods For this mixed-method study, we combined analysis of routine consultation data from the call-center, 24 interviews with key-informants and two surveys of 150 CHWs. Data were analyzed using constant comparative method of analysis. Results Between March 2020 and June 2021, a total of 35,553 consultations took place via the call center. While the CHWs made extensive use of the call center, they rarely asked for support for potential Covid-19 cases. According to the CHWs, there were no signs that people in their communities were suffering from severe health problems due to COVID-19. People compared the lack of visible symptoms to diseases such as Ebola and were skeptical about the danger of COVID-19. At the same time, people in rural areas were afraid to report relevant symptoms and get tested for fear of being quarantined and stigmatized. The telehealth approach did prove useful for other purposes, such as supporting CHWs with their regular tasks and coordinating the supply of essential products. The health professionals at the call center supported CHWs in diagnosing, referring and treating patients and adhering to infection prevention and control practices. The CHWs felt more informed and less isolated, saying the support from the call center helped them to provide better care and improved the supply of medicine and other essential health products. Conclusions The telehealth approach, launched at the start of the COVID-19 pandemic, provided useful support to thousands of CHWs in rural communities in Uganda. The telehealth approach could be quickly set up and scaled up and offers a low cost strategy for providing useful and flexible support to CHWs in rural communities.
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Affiliation(s)
- Maarten Olivier Kok
- grid.6906.90000000092621349Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
| | - Tosca Terra
- Healthy Entrepreneurs Foundation, Kampala, Uganda
| | - Raymond Tweheyo
- grid.11194.3c0000 0004 0620 0548Department of Health Policy Planning and Management, Makerere University, Kampala, Uganda
| | - Marinka van der Hoeven
- grid.16872.3a0000 0004 0435 165XAmsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Maiza Campos Ponce
- grid.16872.3a0000 0004 0435 165XAmsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Marceline Tutu van Furth
- grid.509540.d0000 0004 6880 3010Amsterdam UMC, Vrije Universiteit Amsterdam Infectious Diseases, Amsterdam, The Netherlands
| | - Elizeus Rutebemberwa
- grid.11194.3c0000 0004 0620 0548Department of Health Policy Planning and Management, Makerere University, Kampala, Uganda
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Govender S, Vallabhjee AL, Charles CR, Roesch D, Balton S. Bridging the Access Gap: The Telepractice Experience of Speech Therapists and Audiologists at a Public Health Care Facility in South Africa. Int J Telerehabil 2022; 14:e6517. [PMID: 38026559 PMCID: PMC10681049 DOI: 10.5195/ijt.2022.6517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Abstract
South Africa is a low to middle income country (LMIC) with a population of 60 million people. The public health sector serves more than 80% of the population. Chris Hani Baragwanath Academic Hospital is a central level public health care facility situated in Gauteng. The Speech Therapy and Audiology Department provides insight into their telepractice services through a qualitative approach. The onset of the COVID-19 pandemic resulted in therapists exploring telepractice as a sustainable model of service delivery. Therapists and patients encountered many challenges to the implementation of telepractice, however, the commitment of therapists ensured that creative solutions were developed. A comprehensive needs analysis at public health institutions is required to ensure the sustainability of telepractice. A hybrid model (telepractice and in-person consults) holds the potential to reduce the financial burden on patients and increase access to quality patient-centered care.
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Affiliation(s)
- Shelissa Govender
- Department of Speech Therapy and Audiology, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Annika L. Vallabhjee
- Department of Speech Therapy and Audiology, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Chenay R. Charles
- Department of Speech Therapy and Audiology, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Darike Roesch
- Department of Speech Therapy and Audiology, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Sadna Balton
- Department of Speech Therapy and Audiology, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
- Centre for Augmentative and Alternative Communication, University of Pretoria, Pretoria, South Africa
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3
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Mahmoud K, Jaramillo C, Barteit S. Telemedicine in Low- and Middle-Income Countries During the COVID-19 Pandemic: A Scoping Review. Front Public Health 2022; 10:914423. [PMID: 35812479 PMCID: PMC9257012 DOI: 10.3389/fpubh.2022.914423] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 05/30/2022] [Indexed: 01/14/2023] Open
Abstract
Background COVID-19 has impacted the capacity of healthcare systems worldwide, particularly in low- and middle-income countries (LMICs), which are already under strain due to population growth and insufficient resources. Since the COVID-19 pandemic's emergence, there has been an urgent need for a rapid and adequate reaction to the pandemic's disruption of healthcare systems. To this end, telemedicine has been shown in prior research to be a feasible approach. The overarching objective of this scoping review was to determine the extent and acceptance of telemedicine in healthcare in low- and middle-income countries (LMICs) during the COVID-19 pandemic. Methods This scoping review followed PRISMA guidelines and Arksey and O'Malley's five-stage framework to identify available evidence. We systematically searched four academic databases for peer-reviewed literature published between January 2020 and April 2021: Medline, PubMed, Web of Science, and Scopus, as well as Google Scholar as a source for grey literature. Results The search identified 54 articles with 45,843 participants, including 6,966 healthcare professionals and 36,877 healthcare users. We identified a range of reasons for introducing telemedicine in LMICs during COVID-19, most notably to maintain non-emergency healthcare, enhance access to healthcare providers, and reduce the risk of infection among health users and providers. Overall, healthcare providers and users have shown a high level of acceptance for telemedicine services. During the COVID-19 pandemic, telemedicine provided access to healthcare in the majority of included articles. Nonetheless, some challenges to accepting telemedicine as a method of healthcare delivery have been reported, including technological, regulatory, and economical challenges. Conclusion Telemedicine was found to improve access to high-quality healthcare and decrease infection risk in LMICs during COVID-19. In general, infrastructure and regulatory barriers found to be the most significant barriers to wider telemedicine use, and should be considered when implementing telemedicine more broadly. There appears to be a need to prioritize patient data safety, as many healthcare practitioners utilized commercial apps and services as telemedicine systems. Additionally, it appears as though there is a need to increase capacity, skill, and transparency, as well as to educate patients about telemedicine.
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4
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Mbunge E, Batani J, Gaobotse G, Muchemwa B. Virtual healthcare services and digital health technologies deployed during coronavirus disease 2019 (COVID-19) pandemic in South Africa: a systematic review. GLOBAL HEALTH JOURNAL 2022; 6:102-113. [PMID: 35282399 PMCID: PMC8897959 DOI: 10.1016/j.glohj.2022.03.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 02/08/2022] [Accepted: 03/03/2022] [Indexed: 12/26/2022] Open
Abstract
Aims To identify virtual healthcare services and digital health technologies deployed in South Africa during coronavirus disease 2019 (COVID-19) and the challenges associated with their use. Methods To determine the status of digital health utilization during COVID-19 in South Africa, the preferred reporting items for systematic reviews and meta-analyses model was used to perform a systematic and in-depth critical analysis of previously published studies in well-known and trusted online electronic databases using specific search keywords words that are relevant to this study. We selected published peer-reviewed articles available from the onset of COVID-19 to July 2021. Results Total of 24 articles were included into this study. This study revealed that South Africa adopted digital technologies such as SMS-based solutions, mobile health applications, telemedicine and telehealth, WhatsApp-based systems, artificial intelligence and chatbots and robotics to provide healthcare services during COVID-19 pandemic. These innovative technologies have been used for various purposes including screening infectious and non-infectious diseases, disease surveillance and monitoring, medication and treatment compliance, creating awareness and communication. The study also revealed that teleconsultation and e-prescription, telelaboratory and telepharmacy, teleeducation and teletraining, teledermatology, teleradiology, telecardiology, teleophthalmology, teleneurology, telerehabilitation, teleoncology and telepsychiatry are among virtual healthcare services delivered through digital health technologies during COVID-19 in South Africa. However, these smart digital health technologies face several impediments such as infrastructural and technological barriers, organization and financial barriers, policy and regulatory barriers as well as cultural barriers. Conclusion Although COVID-19 has invigorated the use of digital health technologies, there are still some shortcomings. The outbreak of pandemics like COVID-19 in the future is not inevitable. Therefore, we recommend increasing community networks in rural areas to bridge the digital divide and the modification of mHealth policy to advocate for the effective use of innovative technologies in healthcare and the development of sustainable strategies for resources mobilization through private-public partnerships as well as joining available international initiatives advocating for smart digital health.
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Affiliation(s)
- Elliot Mbunge
- Department of Computer Science, Faculty of Science and Engineering, University of Eswatini, Kwaluseni, Manzini, Eswatini
- Department of Information Technology, Faculty of Accounting and Informatics, Durban University of Technology, South Africa
| | - John Batani
- Faculty of Engineering and Technology, Botho University, Lesotho
| | - Goabaone Gaobotse
- Department of Biological Sciences and Biotechnology, Faculty of Science, Botswana International University of Science and Technology, Botswana
| | - Benhildah Muchemwa
- Department of Computer Science, Faculty of Science and Engineering, University of Eswatini, Kwaluseni, Manzini, Eswatini
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5
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Wechsler LR, Koralnik IJ. Global Teleneurology. Ann Neurol 2022; 91:443-444. [PMID: 35218048 DOI: 10.1002/ana.26334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 02/23/2022] [Indexed: 11/12/2022]
Affiliation(s)
- Lawrence R Wechsler
- Department of Neurology, University of Pennsylvania and Perelman School of Medicine
| | - Igor J Koralnik
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
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6
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Abstract
The accelerating integration of telehealth technologies in neurology practice has transformed traditional interactions between neurologists and patients, allied clinicians and society. Despite the immense promise of these technologies to improve systems of neurological care, the infusion of telehealth technologies into neurology practice introduces a host of unique ethical challenges. Proactive consideration of the ethical dimensions of teleneurology and of the impact of these innovations on the field of neurology more generally can help to ensure responsible development and deployment across stages of implementation. Toward these ends, this article explores key ethical dimensions of teleneurology practice and policy, presents a normative framework for their consideration, and calls attention to underexplored questions ripe for further study at this evolving nexus of teleneurology and neuroethics. To promote successful and ethically resilient development of teleneurology across diverse contexts, clinicians, organizational leaders, and information technology specialists should work closely with neuroethicists with the common goal of identifying and rigorously assessing the trajectories and potential limits of teleneurology systems.
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Affiliation(s)
- Michael J Young
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
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7
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Mbunge E, Muchemwa B, Batani J. Are we there yet? Unbundling the potential adoption and integration of telemedicine to improve virtual healthcare services in African health systems. SENSORS INTERNATIONAL 2022; 3:100152. [PMID: 34901894 PMCID: PMC8648577 DOI: 10.1016/j.sintl.2021.100152] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/02/2021] [Accepted: 12/02/2021] [Indexed: 01/14/2023] Open
Abstract
Since the outbreak of COVID-19, the attention has now shifted towards universal vaccination to gracefully lift strict COVID-19 restrictions previously imposed to contain the spread of the disease. Sub-Saharan Africa is experiencing an exponential increase of infections and deaths coupled with vaccines shortages, personal protective equipment, weak health systems and COVID-19 emerging variants. Some developed countries integrated telemedicine to reduce the impacts of the shortage of healthcare professionals and potentially reduce the risk of exposure, ensuring easy delivery of quality health services while limiting regular physical contact and direct hospitalization. However, the adoption of telemedicine and telehealth is still nascent in many sub-Saharan Africa countries. Therefore, this study reflects on progress made towards the use of telemedicine, virtual health care services, challenges encountered, and proffers ways to address them. We conducted a systematic literature review to synthesise literature on telemedicine in sub-Saharan Africa. The study revealed that telemedicine provides unprecedented benefits such as improving efficiency, effective utilization of healthcare resources, forward triaging, prevention of medical personnel infection, aiding medical students' clinical observation and participation, and assurance of social support for patients. However, the absence of policy on virtual care and political will, cost of sustenance of virtual health care services, inadequate funding, technological and infrastructural barriers, patient and healthcare personnel bias on virtual care and cultural barriers are identified as limiting factors to the adoption of virtual health care in many African health systems. To alleviate some of these barriers, we recommend the development of robust policies and frameworks for virtual health care, the inclusion of virtual care in the medical school curriculum, supporting virtual care research and development, increasing health funding, removing monopolisation of telecommunication services, developing of virtual health solutions that address eccentricities of African health systems.
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Affiliation(s)
- Elliot Mbunge
- Department of Computer Science, Faculty of Science and Engineering, University of Eswatini, Private Bag 4, Kwaluseni, Eswatini,Corresponding author
| | - Benhildah Muchemwa
- Department of Computer Science, Faculty of Science and Engineering, University of Eswatini, Private Bag 4, Kwaluseni, Eswatini
| | - John Batani
- Faculty of Engineering and Technology, Botho University, Maseru, Lesotho
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8
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Dodoo JE, Al-Samarraie H, Alsswey A. The development of telemedicine programs in Sub-Saharan Africa: Progress and associated challenges. HEALTH AND TECHNOLOGY 2021; 12:33-46. [PMID: 34849325 PMCID: PMC8613515 DOI: 10.1007/s12553-021-00626-7] [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: 08/06/2021] [Accepted: 11/18/2021] [Indexed: 12/30/2022]
Abstract
Monitoring the progress of telemedicine use in Sub-Saharan Africa (SSA) countries has received a considerable attention from many health organizations and governmental agencies. This study reviewed the current progress and challenges in relation to the development of telemedicine programs in SSA. The results from reviewing 66 empirical studies revealed an unbalanced progress across SSA countries. Further, technological, organisational, legal and regulatory, individual, financial, and cultural aspects were identified as the major barriers to the success of telemedicine development in SSA. This study reported the current trends in telemedicine application, as well as highlighting critical barriers for consideration by healthcare decision makers. The outcomes from this study offer a number of recommendations to support wider implementation and sustainable usage of telemedicine in SSA.
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Affiliation(s)
- Joana Eva Dodoo
- College of Distance Education, Department of Business Studies, University of Cape Coast, Cape Coast, Ghana.,College of Distance Education, Department of Business Studies, University of Cape Coast, Cape Coast, Ghana
| | - Hosam Al-Samarraie
- School of Design, University of Leeds, Leeds, UK.,Centre for Instructional Technology & Multimedia, Universiti Sains Malaysia, Penang, Malaysia
| | - Ahmed Alsswey
- Department of Multimedia Technology, AL-Zaytoonah University of Jordan, Amman, Jordan
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9
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Chitungo I, Mhango M, Mbunge E, Dzobo M, Musuka G, Dzinamarira T. Utility of telemedicine in sub-Saharan Africa during the COVID-19 pandemic. A rapid review. HUMAN BEHAVIOR AND EMERGING TECHNOLOGIES 2021; 3:843-853. [PMID: 34901772 PMCID: PMC8653215 DOI: 10.1002/hbe2.297] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/01/2021] [Indexed: 12/23/2022]
Abstract
Telemedicine is the use of technology to achieve remote care. This review looks at the utility of telemedicine during the pandemic, period March 2020 to February 2021. Eleven articles met inclusion criteria. There was moderate use of telemedicine in sub‐Sahara Africa during the pandemic, however, there were also some limitations. Benefits of telemedicine include continuing medical service provision, connecting relatives with loved ones in quarantine, education, and awareness of mental health issues, and toxicovigilance and infection control. Challenges to the implementation of telemedicine on the continent were lack of supporting telemedicine framework and policies, digital barriers, and patient and healthcare personnel biases. To address these challenges, this article proposes the development of policy frameworks that fosters telemedicine use by all stakeholders, including medical insurance organizations, the introduction of telemedicine training of medical workers, educational awareness programs for the public, and improvement of digital platforms access and affordability.
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Affiliation(s)
- Itai Chitungo
- Department of Laboratory Diagnostics and Investigative Science, Faculty of Medicine and Health Sciences University of Zimbabwe Harare Zimbabwe
| | - Malizgani Mhango
- School of Public Health University of Western Cape Cape Town South Africa
| | - Elliot Mbunge
- Department of Computer Science, Faculty of Science and Engineering University of Eswatini (formerly Swaziland) Kwaluseni Eswatini
| | - Mathias Dzobo
- Department of Laboratory Diagnostics and Investigative Science, Faculty of Medicine and Health Sciences University of Zimbabwe Harare Zimbabwe
| | | | - Tafadzwa Dzinamarira
- ICAP at Columbia University Harare Zimbabwe.,School of Health Systems & Public Health University of Pretoria Pretoria South Africa
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Srivastava A, Swaminathan A, Chockalingam M, Srinivasan MK, Surya N, Ray P, Hegde PS, Akkunje PS, Kamble S, Chitnis S, Kamalakannan S, Ganvir S, Shah U. Tele-Neurorehabilitation During the COVID-19 Pandemic: Implications for Practice in Low- and Middle-Income Countries. Front Neurol 2021; 12:667925. [PMID: 34690907 PMCID: PMC8529345 DOI: 10.3389/fneur.2021.667925] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 08/23/2021] [Indexed: 11/13/2022] Open
Abstract
The importance of neurorehabilitation services for people with disabilities is getting well-recognized in low- and middle-income countries (LMICs) recently. However, accessibility to the same has remained the most significant challenge, in these contexts. This is especially because of the non-availability of trained specialists and the availability of neurorehabilitation centers only in urban cities owned predominantly by private healthcare organizations. In the current COVID-19 pandemic, the members of the Task Force for research at the Indian Federation of Neurorehabilitation (IFNR) reviewed the context for tele-neurorehabilitation (TNR) and have provided the contemporary implications for practicing TNR during COVID-19 for people with neurological disabilities (PWNDs) in LMICs. Neurorehabilitation is a science that is driven by rigorous research-based evidence. The current pandemic implies the need for systematically developed TNR interventions that is evaluated for its feasibility and acceptability and that is informed by available evidence from LMICs. Given the lack of organized systems in place for the provision of neurorehabilitation services in general, there needs to be sufficient budgetary allocations and a sector-wide approach to developing policies and systems for the provision of TNR services for PWNDs. The pandemic situation provides an opportunity to optimize the technological innovations in health and scale up these innovations to meet the growing burden of neurological disability in LMICs. Thus, this immense opportunity must be tapped to build capacity for safe and effective TNR services provision for PWNDs in these settings.
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Affiliation(s)
- Abhishek Srivastava
- Centre for Physical Medicine and Rehabilitation, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
| | | | | | - Murali K Srinivasan
- Faculty of Occupational Therapy, Meenakshi Academy of Higher Education and Research, Chennai, India
| | - Nirmal Surya
- Chairman Surya Neuro Centre Mumbai, President Indian Federation of Neurorehabilitation (IFNR), Mumbai, India
| | - Partha Ray
- National Health Services England, The Walton Centre Liverpool & National Professor of Neurology, Liverpool, United Kingdom
| | - Prasanna S Hegde
- Deglutology and Speech-Language Pathology, HCG Hospital, Bangalore, India
| | - Preetie Shetty Akkunje
- Department of Speech Pathology and Audiology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Sanjivani Kamble
- Dr. D. Y. Patil College of Physiotherapy, Dr. D. Y. Patil Vidyapeeth, Pune, India
| | - Sonal Chitnis
- Bharati Vidyapeeth (Deemed to be) University, School of Audiology Speech Language Pathology, Pune, India
| | - Sureshkumar Kamalakannan
- South Asia Centre for Disability Inclusive Development and Research (SACDIR), Public Health Foundation of India, The Indian Institute of Public Health Hyderabad, Hyderabad, India
| | - Suvarna Ganvir
- Department of Neuro Physiotherapy, Dr. Vitalrao Vikhe Patil Foundation's College of Physiotherapy, Ahmednagar, India
| | - Urvashi Shah
- Department of Neurology, King Edward Memorial and Global Hospitals Mumbai, Mumbai, India
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Ain HQU, Tahir MJ, Waheed S, Ahmad S, Ullah I, Yousaf Z. Teleradiology in COVID-19: A Sustainable Innovative Solution. Acad Radiol 2021; 28:1325-1326. [PMID: 34312060 PMCID: PMC8286871 DOI: 10.1016/j.acra.2021.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 06/13/2021] [Accepted: 06/14/2021] [Indexed: 11/25/2022]
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