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Puthenparampil M, Stivanello C, Bano MC, Tessarin M, Martello T, Rinaldi F, Perini P, Gallo P. Telehealth Feasibility, Interest, and Satisfaction of Patients with Multiple Sclerosis Living in the Veneto Region, Italy, During the COVID-19 Pandemic. Telemed J E Health 2024. [PMID: 39049787 DOI: 10.1089/tmj.2024.0144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024] Open
Abstract
Introduction: Synchronous telehealth (ST) consists of the remote real-time delivery of health services. COVID-19 pandemic has pressed the use of ST and forced neurologists to deliver telehealth services. The aim of this study was to obtain the actual picture of ST accessibility/interest and to evaluate the user satisfaction in patients with multiple sclerosis (MS) during the COVID-19 pandemic. Methods: The study consisted of two phases. First, a hard-copy questionnaire ("Telehealth Identity Card" [TIC]), including only yes/no questions, filled in the presence of a neurologist, and investigating the technical/practical access and the willingness/interest of MS patients to the telehealth services, was obtained from 600 consecutive outpatients, with no time limit for answering. Second, a fully filled "Televisit Satisfaction Questionnaire" (TSQ) was obtained from 100 consecutive patients that underwent a televisit. Statistical analysis applied the t test for normally distributed variables and the Mann-Whitney U test for ordinal. Logistic univariate and multivariate regressions were applied to predict televisit availability on the base of demographic variables. Results: Statistical analysis was performed on 552/600 consecutive TIC (92%). Of them, 464/552 (84%) of the MS patients declared to possess the tools and to be interested in telehealth services. Compared with noninterested patients, they were younger (mean age: 44.0 vs. 49.8, p < 0.001) and with lower disability (mean Expanded Disability Status Scale: 2.5 vs. 3.3, p < 0.01). From TSQ, it emerged that 95% agree or strongly agree that televisit respected timelines, saved time and money, was conducted with respect to privacy, can be a useful tool for monitoring disease and therapy, and expressed their availability for further televisits. Discussion: A great majority of MS patients living in Padua Province were interested in telehealth. High satisfaction and the willingness for further televist were expressed. Telehealth services can help neurologists to manage the increasing number of MS patients and their complex therapeutic monitoring.
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Affiliation(s)
- Marco Puthenparampil
- Multiple Sclerosis Centre and Unit of Day Hospital & Advanced Therapies in Neurology, Neurology Unit, Azienda Ospedaliera di Padova, Padova, Italy
- Department of Neuroscience, Università degli Studi di Padova, Padova, Italy
| | - Celeste Stivanello
- Multiple Sclerosis Centre and Unit of Day Hospital & Advanced Therapies in Neurology, Neurology Unit, Azienda Ospedaliera di Padova, Padova, Italy
| | - Maria Chiara Bano
- General, Administrative and Health Management Unit, Azienda Ospedaliera di Padova, Padova, Italy
| | - Michele Tessarin
- General, Administrative and Health Management Unit, Azienda Ospedaliera di Padova, Padova, Italy
| | - Tiziano Martello
- Hospital Medical Management Unit, Azienda Ospedaliera di Padova, Padova, Italy
| | - Francesca Rinaldi
- Multiple Sclerosis Centre and Unit of Day Hospital & Advanced Therapies in Neurology, Neurology Unit, Azienda Ospedaliera di Padova, Padova, Italy
| | - Paola Perini
- Multiple Sclerosis Centre and Unit of Day Hospital & Advanced Therapies in Neurology, Neurology Unit, Azienda Ospedaliera di Padova, Padova, Italy
| | - Paolo Gallo
- Multiple Sclerosis Centre and Unit of Day Hospital & Advanced Therapies in Neurology, Neurology Unit, Azienda Ospedaliera di Padova, Padova, Italy
- Department of Neuroscience, Università degli Studi di Padova, Padova, Italy
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Angelopoulou E, Koros C, Stanitsa E, Stamelos I, Kontaxopoulou D, Fragkiadaki S, Papatriantafyllou JD, Smaragdaki E, Vourou K, Pavlou D, Bamidis PD, Stefanis L, Papageorgiou SG. Neurological Examination via Telemedicine: An Updated Review Focusing on Movement Disorders. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:958. [PMID: 38929575 PMCID: PMC11205653 DOI: 10.3390/medicina60060958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 06/05/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024]
Abstract
Patients with movement disorders such as Parkinson's disease (PD) living in remote and underserved areas often have limited access to specialized healthcare, while the feasibility and reliability of the video-based examination remains unclear. The aim of this narrative review is to examine which parts of remote neurological assessment are feasible and reliable in movement disorders. Clinical studies have demonstrated that most parts of the video-based neurological examination are feasible, even in the absence of a third party, including stance and gait-if an assistive device is not required-bradykinesia, tremor, dystonia, some ocular mobility parts, coordination, and gross muscle power and sensation assessment. Technical issues (video quality, internet connection, camera placement) might affect bradykinesia and tremor evaluation, especially in mild cases, possibly due to their rhythmic nature. Rigidity, postural instability and deep tendon reflexes cannot be remotely performed unless a trained healthcare professional is present. A modified version of incomplete Unified Parkinson's Disease Rating Scale (UPDRS)-III and a related equation lacking rigidity and pull testing items can reliably predict total UPDRS-III. UPDRS-II, -IV, Timed "Up and Go", and non-motor and quality of life scales can be administered remotely, while the remote Movement Disorder Society (MDS)-UPDRS-III requires further investigation. In conclusion, most parts of neurological examination can be performed virtually in PD, except for rigidity and postural instability, while technical issues might affect the assessment of mild bradykinesia and tremor. The combined use of wearable devices may at least partially compensate for these challenges in the future.
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Affiliation(s)
- Efthalia Angelopoulou
- 1st Department of Neurology, Aiginition University Hospital, Vasilissis Sofias Street 72-74, 11528 Athens, Greece; (E.A.); (E.S.); (I.S.); (D.K.); (S.F.); (J.D.P.); (E.S.); (K.V.); (L.S.); (S.G.P.)
| | - Christos Koros
- 1st Department of Neurology, Aiginition University Hospital, Vasilissis Sofias Street 72-74, 11528 Athens, Greece; (E.A.); (E.S.); (I.S.); (D.K.); (S.F.); (J.D.P.); (E.S.); (K.V.); (L.S.); (S.G.P.)
| | - Evangelia Stanitsa
- 1st Department of Neurology, Aiginition University Hospital, Vasilissis Sofias Street 72-74, 11528 Athens, Greece; (E.A.); (E.S.); (I.S.); (D.K.); (S.F.); (J.D.P.); (E.S.); (K.V.); (L.S.); (S.G.P.)
| | - Ioannis Stamelos
- 1st Department of Neurology, Aiginition University Hospital, Vasilissis Sofias Street 72-74, 11528 Athens, Greece; (E.A.); (E.S.); (I.S.); (D.K.); (S.F.); (J.D.P.); (E.S.); (K.V.); (L.S.); (S.G.P.)
| | - Dionysia Kontaxopoulou
- 1st Department of Neurology, Aiginition University Hospital, Vasilissis Sofias Street 72-74, 11528 Athens, Greece; (E.A.); (E.S.); (I.S.); (D.K.); (S.F.); (J.D.P.); (E.S.); (K.V.); (L.S.); (S.G.P.)
| | - Stella Fragkiadaki
- 1st Department of Neurology, Aiginition University Hospital, Vasilissis Sofias Street 72-74, 11528 Athens, Greece; (E.A.); (E.S.); (I.S.); (D.K.); (S.F.); (J.D.P.); (E.S.); (K.V.); (L.S.); (S.G.P.)
| | - John D. Papatriantafyllou
- 1st Department of Neurology, Aiginition University Hospital, Vasilissis Sofias Street 72-74, 11528 Athens, Greece; (E.A.); (E.S.); (I.S.); (D.K.); (S.F.); (J.D.P.); (E.S.); (K.V.); (L.S.); (S.G.P.)
| | - Evangelia Smaragdaki
- 1st Department of Neurology, Aiginition University Hospital, Vasilissis Sofias Street 72-74, 11528 Athens, Greece; (E.A.); (E.S.); (I.S.); (D.K.); (S.F.); (J.D.P.); (E.S.); (K.V.); (L.S.); (S.G.P.)
| | - Kalliopi Vourou
- 1st Department of Neurology, Aiginition University Hospital, Vasilissis Sofias Street 72-74, 11528 Athens, Greece; (E.A.); (E.S.); (I.S.); (D.K.); (S.F.); (J.D.P.); (E.S.); (K.V.); (L.S.); (S.G.P.)
| | - Dimosthenis Pavlou
- School of Topography and Geoinformatics, University of West Attica, Ag. Spyridonos Str., 12243 Aigalew, Greece;
| | - Panagiotis D. Bamidis
- Lab of Medical Physics and Digital Innovation, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Leonidas Stefanis
- 1st Department of Neurology, Aiginition University Hospital, Vasilissis Sofias Street 72-74, 11528 Athens, Greece; (E.A.); (E.S.); (I.S.); (D.K.); (S.F.); (J.D.P.); (E.S.); (K.V.); (L.S.); (S.G.P.)
| | - Sokratis G. Papageorgiou
- 1st Department of Neurology, Aiginition University Hospital, Vasilissis Sofias Street 72-74, 11528 Athens, Greece; (E.A.); (E.S.); (I.S.); (D.K.); (S.F.); (J.D.P.); (E.S.); (K.V.); (L.S.); (S.G.P.)
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Ranu J, Hoffman KR, Sauers-Ford HS, Williams J, Rosenthal JL. A Qualitative Intervention Evaluation of Neonatal Virtual Family-Centered Rounds. Hosp Pediatr 2024; 14:463-473. [PMID: 38774983 PMCID: PMC11137623 DOI: 10.1542/hpeds.2023-007554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 02/06/2024] [Indexed: 06/01/2024]
Abstract
OBJECTIVE To conduct an implementation evaluation of the virtual family-centered rounds (FCR) intervention by exploring the perceptions and experiences of parents and care team providers. METHODS We conducted a qualitative descriptive study using a thematic analysis of unobtrusive observations of rounding encounters and semi-structured interviews with the parents of discharged infants and members of the neonatal care team. Eligible participants had used virtual FCR at least once. Five research team members independently performed focused coding and memo writing of transcripts and observation fieldnotes. The team met weekly to compare and refine codes, update the interview guide, develop tentative categories, and discuss the theoretical direction. RESULTS We conducted 406 minutes of unobtrusive observations and 21 interviews with parents, physicians, neonatal nurse practitioners, bedside nurses, dieticians, and pharmacists. Three themes and 13 subthemes emerged from the analysis: (1) virtual FCR improved perceived care delivery and clinical outcomes through increased opportunities for parent engagement, (2) the acceptance of virtual FCR by providers grew over time despite the persistent presence of technical challenges, and (3) the implementation of virtual FCR should be standardized and delivered by the care team to enhance usability, effectiveness, and sustainability. CONCLUSIONS Virtual FCR is perceived by NICU parents and care team providers to be a valuable intervention that can enhance family centered care. The identified virtual FCR implementation strategies should be tested in further studies.
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Affiliation(s)
- Jaskiran Ranu
- Mercy San Juan Medical Center, Carmichael, California
| | - Kristin R. Hoffman
- Department of Pediatrics, University of California Davis, Sacramento, California
| | - Hadley S. Sauers-Ford
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Jacob Williams
- Graduate School of Biomedical Sciences & Professional Studies, Drexel University, Philadelphia, Pennsylvania
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Bostan S, Yesildag AY, Balci F. Family Physicians' Perspectives on the Pros, Cons, and Application Areas of Telemedicine: A Qualitative Study. Telemed J E Health 2024; 30:1450-1458. [PMID: 38294897 DOI: 10.1089/tmj.2023.0574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024] Open
Abstract
Background: There is evidence that telemedicine can be used safely, easily, and cost-effectively in primary health care services. This study aims to determine family physicians' opinions regarding the potential advantages, disadvantages, and usage areas of telemedicine in primary health care services. Methods: This study was designed with a qualitative case study. The Standards for Reporting Qualitative Research (SRQR) checklist was followed throughout the research process. Interviews were conducted with family physicians working in a provincial center using snowball sampling in the study. MaxQDA 20 software was used for analysis process, and themes and subthemes were identified through a deductive-reflective thematic analysis method. The family physicians who participated in the study are between 29 and 56. In addition, family medicine specialists, general practitioners, and academic department heads were included in the study. Family physicians are evenly distributed in terms of gender and professional experience. Results: All interviewed family physicians stated that they had not received professional or technical training in delivering telemedicine. It was observed that family physicians had different perspectives on telemedicine in primary care. The data obtained in the study were analyzed under the main themes of the advantages, disadvantages, and services that can be provided in primary telemedicine. Physicians have different views on telemedicine, including negative, undecided, and positive opinions. Conclusion: It is understood that many services could be delivered remotely if the scope, procedures, and processes of the services to be provided are determined with guidelines. It is recommended that family physicians receive professional and technical training in telemedicine.
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Affiliation(s)
- Sedat Bostan
- Health Management Department, Karadeniz Technical University, Trabzon, Turkey
| | - Ahmet Y Yesildag
- Health Management Department, Karadeniz Technical University, Trabzon, Turkey
- Health Sciences Institute, Ankara University, Ankara, Turkey
| | - Fatma Balci
- Health Management Department, Karadeniz Technical University, Trabzon, Turkey
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Ganiele MDLN, Weisbrot MA, Sian AM, Carosella Reboredo JM, Weisbrot MV, Grande Ratti MF. [Scope and limitations of teleconsultation during the covid-19 pandemic: accounts from primary healthcare professionals in the Autonomous City of Buenos Aires]. Salud Colect 2024; 20:e4579. [PMID: 38381119 DOI: 10.18294/sc.2024.4579] [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: 07/24/2023] [Accepted: 01/19/2024] [Indexed: 02/22/2024] Open
Abstract
The aim was to explore the scope and limitations of teleconsultation during the pandemic from the perspective of primary care physicians at the Hospital Italiano de Buenos Aires, a private institution located in the Autonomous City of Buenos Aires. A qualitative study was conducted with ten individual semi-structured interviews between January and April 2022. The three major emerging topics were the transition to virtuality, accessibility, and the new care model. Obstacles were related to the massive, forced, and unplanned implementation of teleconsultations. The main benefits included providing care during isolation-distancing and addressing epidemiological doubts. Changes were highlighted in care strategies, consultation frameworks, exchange among colleagues, referral criteria, requests for complementary studies, and in the profiles of those seeking consultations. A misuse of the system by individuals and a trivialization of the consultation moment emerged. The rise of communication and information technologies undoubtedly allowed the continuity of healthcare processes, but it does not replace in-person care, and normative guidelines are needed for its continuity.
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Affiliation(s)
- María de Las Nieves Ganiele
- Médica, investigadora, docente, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Mariela Alejandra Weisbrot
- Magíster en Epidemiología, Gestión y Políticas de Salud. Investigadora, docente, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Andrea Melissa Sian
- Estudiante de Medicina, Instituto Universitario Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | | | - María Victoria Weisbrot
- Socióloga. Investigadora, project manager, Instituto Universitario Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - María Florencia Grande Ratti
- Doctora en Ciencias de la Salud. Investigadora, Consejo Nacional de Investigaciones Científicas y Técnicas. Docente, Instituto Universitario Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
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Ahmed A, Mutahar M, Daghrery AA, Albar NH, Alhadidi IQI, Asiri AM, Boreak N, Alshahrani AAS, Shariff M, Shubayr MA, Al Moaleem MM. A Systematic Review of Publications on Perceptions and Management of Chronic Medical Conditions Using Telemedicine Remote Consultations by Primary Healthcare Professionals April 2020 to December 2021 During the COVID-19 Pandemic. Med Sci Monit 2024; 30:e943383. [PMID: 38341609 PMCID: PMC10868410 DOI: 10.12659/msm.943383] [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: 12/05/2023] [Accepted: 12/22/2023] [Indexed: 02/12/2024] Open
Abstract
Telemedicine technologies allow distribution of health-related services and information and can include electronic and telecommunication technologies, remote patient and clinician contact, referral and prescribing, patient education, and monitoring. This systematic review aimed to evaluate publications on the perceptions and management of chronic medical conditions using telehealth remote consultations by primary healthcare professionals between April 2020 and December 2021 during the COVID-19 pandemic. Electronic databases, including Cinhal, PubMed, Science Direct, and ProQuest were searched to extract qualitative studies relevant to the topic. Inclusion criteria were developed based on the Population, Exposure, and Outcomes scoping framework. The target population was healthcare professionals working in primary care settings. Included studies encompassed various types of telemedicine, such as synchronous telemedicine, video conferencing, telephone conversations, and smart devices. Eight studies were included. Synchronous telemedicine was highly effective in ensuring the continuity of care and treatment, providing patients with convenience, improved access to treatment, and earlier disease management. Video conferencing and telephone consultations were the most common methods used. Challenges included concerns about patient privacy, technology literacy, and acceptance. Telemedicine was commended for its ability to provide access to immediate expert medical advice and eliminate the need for long-distance travel, contributing to increased patient compliance. Synchronous telemedicine is a promising solution for managing chronic conditions during and after the COVID-19 pandemic, offering benefits to patients and healthcare professionals. To maximize its potential, concerns regarding patient privacy, confidentiality, and technology literacy need to be addressed. Proper legislation and regulations are required for long-term success of telemedicine, making it a valuable component of healthcare systems.
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Affiliation(s)
- Arzaq Ahmed
- Faculty of Health, School of Health Sciences, Birmingham City University, Birmingham, UK
| | - Mahdi Mutahar
- Dental Academy, University of Portsmouth, Portsmouth, UK
| | - Arwa A. Daghrery
- Department of Restorative Dental Sciences, College of Dentistry, Jazan University, Jazan, Saudi Arabia
| | - Nassreen H. Albar
- Department of Restorative Dental Sciences, College of Dentistry, Jazan University, Jazan, Saudi Arabia
| | - Ismail Qasem I. Alhadidi
- General Dentist, Dental Department, Prince Mohammed bin Nasser Hospital, Ministry of Health, Jazan, Saudi Arabia
| | - Ali Mohammed Asiri
- Dental Department, Restorative Dental Science, Ministry of Health, Abha, Saudi Arabia
| | - Nezar Boreak
- Department of Restorative Dental Sciences, College of Dentistry, Jazan University, Jazan, Saudi Arabia
| | | | - Mansoor Shariff
- Prosthetic Department, College of Dentistry, King Khalid University, Abha, Saudi Arabia
| | - Mosa A. Shubayr
- Division of Dental Public Health, Preventive Dentistry Department, College of Dentistry, Jazan University, Jazan, Saudi Arabia
| | - Mohammed M. Al Moaleem
- Department of Prosthetic Dental Science, College of Dentistry, Jazan University, Jazan, Saudi Arabia
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Haveman ME, Jonker LT, Hermens HJ, Tabak M, de Vries JPP. Effectiveness of current perioperative telemonitoring on postoperative outcome in patients undergoing major abdominal surgery: A systematic review of controlled trials. J Telemed Telecare 2024; 30:215-229. [PMID: 34723689 DOI: 10.1177/1357633x211047710] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Perioperative telemonitoring of patients undergoing major surgery might lead to improved postoperative outcomes. The aim of this systematic review is to evaluate the effectiveness of current perioperative telemonitoring interventions on postoperative clinical, patient-reported, and financial outcome measures in patients undergoing major surgery. METHODS For this systematic review, PubMed, CINAHL, and Embase databases were searched for eligible articles published between January 1, 2009 and March 15, 2021. Studies were eligible as they described: (P) patients aged 18 years or older who underwent major abdominal surgery, (I) perioperative telemonitoring as intervention, (C) a control group receiving usual care, (O) any type of postoperative clinical, patient-reported, or financial outcome measures, and (S) an interventional study design. RESULTS The search identified 2958 articles of which 10 were eligible for analysis, describing nine controlled trials of 2438 patients. Perioperative telemonitoring comprised wearable biosensors (n = 3), websites (n = 3), e-mail (n = 1), and mobile applications (n = 2). Outcome measures were clinical (n = 8), patient-reported (n = 5), and financial (n = 2). Results show significant improvement of recovery time, stoma self-efficacy and pain in the early postoperative phase in patients receiving telemonitoring. Other outcome measures were not significantly different between the groups. CONCLUSION Evidence for the effectiveness of perioperative telemonitoring in major surgery is scarce. There is a need for good quality studies with sufficient patients while ensuring that the quality and usability of the technology and the adoption in care processes are optimal.
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Affiliation(s)
- Marjolein E Haveman
- Department of Surgery, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Leonie T Jonker
- Department of Surgery, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Hermie J Hermens
- Department of Biomedical Signals and Systems, University of Twente, the Netherlands
- eHealth group, Roessingh Research and Development, the Netherlands
| | - Monique Tabak
- Department of Biomedical Signals and Systems, University of Twente, the Netherlands
- eHealth group, Roessingh Research and Development, the Netherlands
| | - Jean-Paul Pm de Vries
- Department of Surgery, University Medical Center Groningen, University of Groningen, the Netherlands
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Farizi SA, Setyowati D, Fatmaningrum DA, Azyanti AF. Telehealth and telemedicine prenatal care during the COVID-19 pandemic: a systematic review with a narrative synthesis. Hosp Pract (1995) 2023; 51:241-254. [PMID: 37968996 DOI: 10.1080/21548331.2023.2284635] [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: 06/02/2023] [Accepted: 11/14/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND The COVID-19 epidemic has restricted the use of maternal health services, including prenatal care. Telehealth and telemedicine are remote services that can help in the event of a COVID-19 pandemic. In this study, we examined the use of telehealth and telemedicine in prenatal care in various countries during the COVID-19 pandemic. METHODS Relevant titles were searched in five e-book databases from 31 December 2019 to 31 July 2021: PUBMED, Science Direct, Scopus, Web of Sciences, and Google Scholar. Articles were chosen based on the following criteria: a focus on pregnant women, a connection to the COVID-19 pandemic, and a focus on telehealth and telemedicine. A narrative synthesis was used to synthesize the data. RESULTS Telehealth and telemedicine reduced the risk of transmitting COVID-19 to pregnant women and health workers. The implementation process encountered various challenges, such as the absence of service composition, limited technological accessibility, communication difficulties, and disparities in access. CONCLUSIONS It is imperative for the government and health organizations to have a comprehensive policy and legislation that effectively regulates the provision of services. It is also important to emphasize the importance of reducing inequality, such as by equalizing access to technology and infrastructure.
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Affiliation(s)
- Sofia Al Farizi
- Midwifery Study Program, Faculty Medicine, Airlangga University, Surabaya, Indonesia
| | - Dewi Setyowati
- Midwifery Study Program, Faculty Medicine, Airlangga University, Surabaya, Indonesia
| | - Dyah Ayu Fatmaningrum
- Midwifery Study Program, Faculty Medicine, Airlangga University, Surabaya, Indonesia
| | - Azra Fauziyah Azyanti
- Midwifery Study Program, Faculty Medicine, Airlangga University, Surabaya, Indonesia
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Pergolizzi J, LeQuang JAK, Vasiliu-Feltes I, Breve F, Varrassi G. Brave New Healthcare: A Narrative Review of Digital Healthcare in American Medicine. Cureus 2023; 15:e46489. [PMID: 37927734 PMCID: PMC10623488 DOI: 10.7759/cureus.46489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/30/2023] [Indexed: 11/07/2023] Open
Abstract
The digital revolution has had a profound effect on American and global healthcare, which was accelerated by the pandemic and telehealth applications. Digital health also includes popular and more esoteric forms of wearable monitoring systems and interscatter and other wireless technologies that facilitate their telemetry. The rise in artificial intelligence (AI) and machine learning (ML) may serve to improve interpretation from imaging technologies to electrocardiography or electroencephalographic tracings, and new ML techniques may allow these systems to scan data to discern and contextualize patterns that may have evaded human physicians. The necessity of virtual care during the pandemic has morphed into new treatment paradigms, which have gained patient acceptance but still raise issues with respect to privacy laws and credentialing. Augmented and virtual reality tools can facilitate surgical planning and "hands-on" clinical training activities. Patients are working with new frontiers in digital health in the form of "Dr. Google" and patient support websites to learn or share medical information. Patient-facing digital health information is both a blessing and curse, in that it can be a boon to health-literate patients who seek to be more active in their own care. On the other hand, digital health information can lead to false conclusions, catastrophizing, misunderstandings, and "cyberchondria." The role of blockchain, familiar from cryptocurrency, may play a role in future healthcare information and would serve as a disruptive, decentralizing, and potentially beneficial change. These important changes are both exciting and perplexing as clinicians and their patients learn to navigate this new system and how we address the questions it raises, such as medical privacy in a digital age. The goal of this review is to explore the vast range of digital health and how it may impact the healthcare system.
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Affiliation(s)
| | | | | | - Frank Breve
- Department of Pharmacy, Temple University, Philadelphia, USA
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Sharma P, Sethi MIS, Liem A, Bhatti HBS, Pandey V, Nair A. A Review of Telemedicine Guidelines in the South-East Asia Region. TELEMEDICINE REPORTS 2023; 4:271-278. [PMID: 37753247 PMCID: PMC10518689 DOI: 10.1089/tmr.2023.0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/30/2023] [Indexed: 09/28/2023]
Abstract
Introduction Telemedicine use has increased for the past few years, and data security-related issues have also accompanied this. Barriers such as poor digital literacy, unaffordability, and ethical and legal issues have also affected the uptake of digital health. Telemedicine guidelines can help in promoting a suitable environment for wider uptake of telemedicine services by focusing on training, supervision, and monitoring of service providers. This policy review compares the telemedicine guidelines of countries in World Health Organization (WHO) South-East Asia Region (SEAR) as these countries have similar sociocultural backgrounds. Methodology Latest telemedicine guidelines of the South Asia Region of the WHO were accessed using the official government websites of the countries. The guidelines that were not in the English language were translated into English using Google Translate. The guidelines were analyzed and presented under the following subheadings: (1) Definitions, Purpose, and Tools of Telemedicine; (2) Clinical Aspects of Telemedicine; and (3) Operational and Technical Aspects of Telemedicine. Results Investigating the telemedicine guidelines in the SEAR of the WHO revealed that only 5 out of 11 countries, that is, India, Bangladesh, Thailand, Indonesia and Nepal, have guidelines specifically for telemedicine. Besides Thailand, the other four countries either published (India, Nepal, and Bangladesh) or updated (Indonesia) their telemedicine guidelines after the onset of the COVID-19 pandemic. Guidelines from India and Bangladesh are detailed and robust compared with those from Nepal, Indonesia, and Thailand. Conclusion Telemedicine guidelines need to be more robust to improve the uptake of the service. Further research is needed to explore the effectiveness of implementing these guidelines.
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Affiliation(s)
- Parth Sharma
- Southeast Asia Region, International Working Group for Health System Strengthening, Delhi, India
- Department of Community Medicine, Maulana Azad Medical College, Delhi, India
| | - Manik Inder Singh Sethi
- Southeast Asia Region, International Working Group for Health System Strengthening, Delhi, India
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Andrian Liem
- Southeast Asia Region, International Working Group for Health System Strengthening, Delhi, India
- Public Health Cluster, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor, Malaysia
| | - Hakikat Bir Singh Bhatti
- Southeast Asia Region, International Working Group for Health System Strengthening, Delhi, India
- Department of Computer Science Engineering, Indraprastha Institute of Information Technology, Delhi, India
| | - Vatsala Pandey
- Southeast Asia Region, International Working Group for Health System Strengthening, Delhi, India
| | - Anoushka Nair
- Southeast Asia Region, International Working Group for Health System Strengthening, Delhi, India
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11
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Agbali RA, Balas EA, Beltrame F, Heboyan V, De Leo G. A review of questionnaires used for the assessment of telemedicine. J Telemed Telecare 2023:1357633X231166161. [PMID: 37032470 DOI: 10.1177/1357633x231166161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
INTRODUCTION Telemedicine is the exchange of medical information from one site to another via electronic communications with the goal of improving a patient's clinical health status. Prior studies have identified the absence of a standardized assessment tool for evaluating telemedicine encounters. This study aims to collect and to analyze questionnaires used for the assessment of audiovisual telemedicine encounters from a patient perspective and aims to identify reasons driving the use of self-developed questionnaires. METHODS We conducted a systematic search in PubMed for studies that used survey questionnaires to assess synchronous audiovisual telemedicine encounters from 2016 to 2021. We categorized questionnaires used into validated and non-validated types, and for each of them, collected questions, response format, author, year, specialty, and country of publication. RESULTS AND DISCUSSION We analyzed a total of 71 articles. We found that only 16 studies used three validated questionnaires. The remaining 55 studies used non-validated questionnaires. Non-validated questionnaires had a high variability in length and used Likert scales, binary responses, multiple choice, and open-ended answers. We found only eight studies in which the authors gave a reason for resorting to designing their own questionnaires. This review reveals insufficient standardized survey questionnaires to be used for the assessment of audiovisual telemedicine encounters. Future research initiatives should focus on developing a standardized and validated instrument well accepted by researchers.
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Affiliation(s)
- Raphael A Agbali
- College of Allied Health Sciences, 1421Augusta University, Augusta, GA, USA
| | - E Andrew Balas
- College of Allied Health Sciences, 1421Augusta University, Augusta, GA, USA
| | - Francesco Beltrame
- Department of Informatics, Bioengineering, Robotics and Systems Engineering, University of Genoa, Genova, Italy
| | - Vahe Heboyan
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Gianluca De Leo
- College of Allied Health Sciences, 1421Augusta University, Augusta, GA, USA
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12
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Esposito S, Rosafio C, Antodaro F, Argentiero A, Bassi M, Becherucci P, Bonsanto F, Cagliero A, Cannata G, Capello F, Cardinale F, Chiriaco T, Consolaro A, Dessì A, Di Mauro G, Fainardi V, Fanos V, Guarino A, Li Calzi G, Lodi E, Maghnie M, Manfredini L, Malorgio E, Minuto N, Modena MG, Montori R, Moscatelli A, Patrone E, Pescio E, Poeta M, Ravelli A, Spelta M, Suppiej A, Vai S, Villa L, Zanini R, Botti R, Gaddi AV. Information and Training on the Use of Telemedicine in Pediatric Population: Consensus Document of the Italian Society of Telemedicine (SIT), of the Italian Society of Preventive and Social Pediatrics (SIPPS), of the Italian Society of Pediatric Primary Care (SICuPP), of the Italian Federation of Pediatric Doctors (FIMP), and of the Syndicate of Family Pediatrician Doctors (SIMPeF). J Pers Med 2023; 13:jpm13020314. [PMID: 36836548 PMCID: PMC9958783 DOI: 10.3390/jpm13020314] [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: 12/26/2022] [Revised: 01/25/2023] [Accepted: 02/09/2023] [Indexed: 02/16/2023] Open
Abstract
Telemedicine has entered the daily lives of doctors, although the digital skills of healthcare professionals still remain a goal to be achieved. For the purpose of a large-scale development of telemedicine, it is necessary to create trust in the services it can offer and to favor their acceptance by healthcare professionals and patients. In this context, information for the patient regarding the use of telemedicine, the benefits that can be derived from it, and the training of healthcare professionals and patients for the use of new technologies are fundamental aspects. This consensus document is a commentary that has the aim of defining the information on and training aspects of telemedicine for pediatric patients and their caregivers, as well as pediatricians and other health professionals who deal with minors. For the present and the future of digital healthcare, there is a need for a growth in the skills of professionals and a lifelong learning approach throughout the professional life. Therefore, information and training actions are important to guarantee the necessary professionalism and knowledge of the tools, as well as a good understanding of the interactive context in which they are used. Furthermore, medical skills can also be integrated with the skills of various professionals (engineers, physicists, statisticians, and mathematicians) to birth a new category of health professionals responsible for building new semiotics, identifying criteria for predictive models to be integrated into clinical practice, standardizing clinical and research databases, and defining the boundaries of social networks and new communication technologies within health services.
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Affiliation(s)
- Susanna Esposito
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
- Correspondence:
| | | | | | - Alberto Argentiero
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Marta Bassi
- Department of Pediatrics, IRCCS Giannina Gaslini, 16147 Genoa, Italy
| | | | | | | | - Giulia Cannata
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Fabio Capello
- UO Territorial Pediatrics, Primary Care Department, AUSL Bologna, 40126 Bologna, Italy
| | - Fabio Cardinale
- Department of Pediatrics and Emergency, Pediatric Hospital Giovanni XXIII, University of Bari, 70124 Bari, Italy
| | - Tiziana Chiriaco
- Health Department, ASL Roma 3, 00125 Rome, Italy
- General Management, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Alessandro Consolaro
- Pediatric and Rheumatology Clinic, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal-Child Sciences (DINOGMI), University of Genoa,16126 Genoa, Italy
| | - Angelica Dessì
- Department of Surgical Sciences, University of Cagliari, 09127 Cagliari, Italy
| | | | - Valentina Fainardi
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Vassilios Fanos
- Department of Surgical Sciences, University of Cagliari, 09127 Cagliari, Italy
| | - Alfredo Guarino
- Section of Pediatrics, Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Giada Li Calzi
- General Management, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Elisa Lodi
- P.A.S.C.I.A. Center (Heart Failure Care Program, Childhood Heart Diseases and Those at Risk), University of Modena and Reggio Emilia, AOU Polyclinic of Modena, 41124 Modena, Italy
| | - Mohamad Maghnie
- Department of Pediatrics, IRCCS Giannina Gaslini, 16147 Genoa, Italy
| | - Luca Manfredini
- Pediatric Pain and Palliative Care Service, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | | | - Nicola Minuto
- Department of Pediatrics, IRCCS Giannina Gaslini, 16147 Genoa, Italy
| | - Maria Grazia Modena
- P.A.S.C.I.A. Center (Heart Failure Care Program, Childhood Heart Diseases and Those at Risk), University of Modena and Reggio Emilia, AOU Polyclinic of Modena, 41124 Modena, Italy
| | - Rossano Montori
- Community Medicine and Primary Care, AUSL Modena, 41124 Modena, Italy
| | - Andrea Moscatelli
- UOC Anesthesia and Intensive Care, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Elisa Patrone
- UOSID Trial Center, IRCCS Giannina Gaslini Institute, 16147 Genoa, Italy
| | - Elena Pescio
- Pediatric and Rheumatology Clinic, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Marco Poeta
- Section of Pediatrics, Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Angelo Ravelli
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal-Child Sciences (DINOGMI), University of Genoa,16126 Genoa, Italy
- Scientific Directorate, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Maddalena Spelta
- Pediatric and Rheumatology Clinic, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Agnese Suppiej
- Pediatric Clinic, Department of Medical Sciences, University of Ferrara, 44124 Ferrara, Italy
| | - Sergio Vai
- Alma Mater University, 40126 Bologna, Italy
| | - Luca Villa
- UOSID Trial Center, IRCCS Giannina Gaslini Institute, 16147 Genoa, Italy
| | - Rinaldo Zanini
- General Management, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Renato Botti
- General Management, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Antonio Vittorino Gaddi
- Center for Metabolic Diseases and Atherosclerosis, University of Bologna, 40126 Bologna, Italy
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13
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Esposito S, Rosafio C, Antodaro F, Argentiero A, Bassi M, Becherucci P, Bonsanto F, Cagliero A, Cannata G, Capello F, Cardinale F, Chiriaco T, Consolaro A, Dessì A, Di Mauro G, Fainardi V, Fanos V, Guarino A, Li Calzi G, Lodi E, Maghnie M, Manfredini L, Malorgio E, Minuto N, Modena MG, Montori R, Moscatelli A, Patrone E, Pescio E, Poeta M, Ravelli A, Spelta M, Suppiej A, Vai S, Villa L, Zanini R, Botti R, Gaddi AV. Use of Telemedicine Healthcare Systems in Children and Adolescents with Chronic Disease or in Transition Stages of Life: Consensus Document of the Italian Society of Telemedicine (SIT), of the Italian Society of Preventive and Social Pediatrics (SIPPS), of the Italian Society of Pediatric Primary Care (SICuPP), of the Italian Federation of Pediatric Doctors (FIMP) and of the Syndicate of Family Pediatrician Doctors (SIMPeF). J Pers Med 2023; 13:jpm13020235. [PMID: 36836469 PMCID: PMC9965862 DOI: 10.3390/jpm13020235] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 02/01/2023] Open
Abstract
Telemedicine is considered an excellent tool to support the daily and traditional practice of the health profession, especially when referring to the care and management of chronic patients. In a panorama in which chronic pathologies with childhood onset are constantly increasing and the improvement of treatments has allowed survival for them into adulthood, telemedicine and remote assistance are today considered effective and convenient solutions both for the chronic patient, who thus receives personalized and timely assistance, and for the doctors, who reduce the need for direct intervention, hospitalizations and consequent management costs. This Consensus document, written by the main Italian Scientific Societies involved in the use of telemedicine in pediatrics, has the objectives to propose an organizational model based on the relationships between the actors who participate in the provision of a telemedicine service aimed at minors with chronic pathologies, identifying specific project links between the areas of telemedicine in the developmental age from the first 1000 days of life to the age adult. The future scenario will have to be able to integrate digital innovation in order to offer the best care to patients and citizens. It will have to be able to provide the involvement of patients from the very beginning of the design of any care pathway, increasing where possible the proximity of the health service to citizens.
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Affiliation(s)
- Susanna Esposito
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
- Correspondence:
| | | | | | - Alberto Argentiero
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Marta Bassi
- Department of Pediatrics, IRCCS Giannina Gaslini, 16147 Genoa, Italy
| | | | | | | | - Giulia Cannata
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Fabio Capello
- UO Territorial Pediatrics, Primary Care Department, AUSL Bologna, 40126 Bologna, Italy
| | - Fabio Cardinale
- UOC of Pediatrics and ED with an Allergy-Pneumological and Immuno-Rheumatological Focus, Giovanni XXIII Pediatric Hospital, University of Bari, 70124 Bari, Italy
| | - Tiziana Chiriaco
- Health Department, ASL Roma 3, 00125 Rome, Italy
- General Management, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Alessandro Consolaro
- Pediatric and Rheumatology Clinic, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal-Child Sciences (DINOGMI), University of Genoa, 16126 Genoa, Italy
| | - Angelica Dessì
- Department of Surgical Sciences, University of Cagliari, 09127 Cagliari, Italy
| | | | - Valentina Fainardi
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Vassilios Fanos
- Department of Surgical Sciences, University of Cagliari, 09127 Cagliari, Italy
| | - Alfredo Guarino
- Section of Pediatrics, Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Giada Li Calzi
- General Management, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Elisa Lodi
- P.A.S.C.I.A. Center (Heart Failure Care Program, Childhood Heart Diseases and Those at Risk), University of Modena and Reggio Emilia, AOU Polyclinic of Modena, 41124 Modena, Italy
| | - Mohamad Maghnie
- Department of Pediatrics, IRCCS Giannina Gaslini, 16147 Genoa, Italy
| | - Luca Manfredini
- Pediatric Pain and Palliative Care Service, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | | | - Nicola Minuto
- Department of Pediatrics, IRCCS Giannina Gaslini, 16147 Genoa, Italy
| | - Maria Grazia Modena
- P.A.S.C.I.A. Center (Heart Failure Care Program, Childhood Heart Diseases and Those at Risk), University of Modena and Reggio Emilia, AOU Polyclinic of Modena, 41124 Modena, Italy
| | - Rossano Montori
- Community Medicine and Primary Care, AUSL Modena, 41124 Modena, Italy
| | - Andrea Moscatelli
- UOC Anesthesia and Intensive Care, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Elisa Patrone
- UOSID Trial Center, IRCCS Giannina Gaslini Institute, 16147 Genoa, Italy
| | - Elena Pescio
- Pediatric and Rheumatology Clinic, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Marco Poeta
- Section of Pediatrics, Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Angelo Ravelli
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal-Child Sciences (DINOGMI), University of Genoa, 16126 Genoa, Italy
- Scientific Directorate, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Maddalena Spelta
- Pediatric and Rheumatology Clinic, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Agnese Suppiej
- Pediatric Clinic, University of Ferrara, 44124 Ferrara, Italy
| | | | - Luca Villa
- UOSID Trial Center, IRCCS Giannina Gaslini Institute, 16147 Genoa, Italy
| | | | - Renato Botti
- General Management, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Antonio Vittorino Gaddi
- Center for Metabolic Diseases and Atherosclerosis, University of Bologna, 40126 Bologna, Italy
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14
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Esposito S, Rosafio C, Antodaro F, Argentiero A, Bassi M, Becherucci P, Bonsanto F, Cagliero A, Cannata G, Capello F, Cardinale F, Chiriaco T, Consolaro A, Dessì A, Di Mauro G, Fainardi V, Fanos V, Guarino A, Li Calzi G, Lodi E, Maghnie M, Manfredini L, Malorgio E, Minuto N, Modena MG, Montori R, Moscatelli A, Patrone E, Pescio E, Poeta M, Ravelli A, Spelta M, Suppiej A, Vai S, Villa L, Zanini R, Botti R, Gaddi AV. Use of Telemedicine Healthcare Systems in Pediatric Assistance at Territorial Level: Consensus Document of the Italian Society of Telemedicine (SIT), of the Italian Society of Preventive and Social Pediatrics (SIPPS), of the Italian Society of Pediatric Primary Care (SICuPP), of the Italian Federation of Pediatric Doctors (FIMP) and of the Syndicate of Family Pediatrician Doctors (SIMPeF). J Pers Med 2023; 13:jpm13020198. [PMID: 36836432 PMCID: PMC9964859 DOI: 10.3390/jpm13020198] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/19/2023] [Accepted: 01/19/2023] [Indexed: 01/24/2023] Open
Abstract
Technological innovation can contribute to a reorganization of healthcare, particularly by supporting the shift in the focus of care from the hospital to the territory, through innovative citizen-centered models, and facilitating access to services in the territory. Health and social care delivery modalities, enabled by telemedicine, are crucial in this regard. The objective of this Consensus document, written by the main Italian Scientific Societies involved in the use of telemedicine in pediatrics, is to define a standard for its use at the territorial level in various declinations in the pediatric field; this paper also identifies priority areas for its application and the types of services that most require intervention and investment. The changes that are underway in digital transformation in all sectors are unstoppable, and for the digital transformation to take place in a productive sense, the contribution of not only all health professionals, but also of patients, is necessary. From this perspective, authors from different backgrounds were involved in the drafting of this Consensus and, in the future, other figures, primarily patients, are expected to be involved. In fact, this belongs to the vision of connected care, in which the citizen/patient actively participates in the treatment path so that they are assisted in a personalized, predictive and preventive way. The future scenario must be able to provide for the involvement of patients from the initial stages of planning any treatment path, even in the pediatric age, and increasing, where possible, the proximity of the health service to the families.
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Affiliation(s)
- Susanna Esposito
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
- Correspondence:
| | | | | | - Alberto Argentiero
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Marta Bassi
- Department of Pediatrics, IRCCS Giannina Gaslini, 16147 Genoa, Italy
| | | | | | | | - Giulia Cannata
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Fabio Capello
- UO Territorial Pediatrics, Primary Care Department, AUSL Bologna, 40126 Bologna, Italy
| | - Fabio Cardinale
- UOC of Pediatrics and ED with an Allergy-Pneumological and Immuno-Rheumatological Focus, Giovanni XXIII Pediatric Hospital, University of Bari, 70124 Bari, Italy
| | - Tiziana Chiriaco
- Health Department, ASL Roma 3, 00125 Rome, Italy
- General Management, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Alessandro Consolaro
- Pediatric and Rheumatology Clinic, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal-Child Sciences (DINOGMI), University of Genoa, 16126 Genoa, Italy
| | - Angelica Dessì
- Department of Surgical Sciences, University of Cagliari, 09127 Cagliari, Italy
| | | | - Valentina Fainardi
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Vassilios Fanos
- Department of Surgical Sciences, University of Cagliari, 09127 Cagliari, Italy
| | - Alfredo Guarino
- Section of Pediatrics, Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Giada Li Calzi
- General Management, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Elisa Lodi
- P.A.S.C.I.A. Center (Heart Failure Care Program, Childhood Heart Diseases and Those at Risk), University of Modena and Reggio Emilia, AOU Polyclinic of Modena, 41124 Modena, Italy
| | - Mohamad Maghnie
- Department of Pediatrics, IRCCS Giannina Gaslini, 16147 Genoa, Italy
| | - Luca Manfredini
- Pediatric Pain and Palliative Care Service, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | | | - Nicola Minuto
- Department of Pediatrics, IRCCS Giannina Gaslini, 16147 Genoa, Italy
| | - Maria Grazia Modena
- P.A.S.C.I.A. Center (Heart Failure Care Program, Childhood Heart Diseases and Those at Risk), University of Modena and Reggio Emilia, AOU Polyclinic of Modena, 41124 Modena, Italy
| | | | - Andrea Moscatelli
- UOC Anesthesia and Intensive Care, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Elisa Patrone
- UOSID Trial Center, IRCCS Giannina Gaslini Institute, 16147 Genoa, Italy
| | - Elena Pescio
- Pediatric and Rheumatology Clinic, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Marco Poeta
- Section of Pediatrics, Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Angelo Ravelli
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal-Child Sciences (DINOGMI), University of Genoa, 16126 Genoa, Italy
- Scientific Directorate, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Maddalena Spelta
- Pediatric and Rheumatology Clinic, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Agnese Suppiej
- Pediatric Clinic, University of Ferrara, 44124 Ferrara, Italy
| | - Sergio Vai
- Alma Mater University, 40126 Bologna, Italy
| | - Luca Villa
- UOSID Trial Center, IRCCS Giannina Gaslini Institute, 16147 Genoa, Italy
| | | | - Renato Botti
- General Management, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Antonio Vittorino Gaddi
- Center for Metabolic Diseases and Atherosclerosis, University of Bologna, 40126 Bologna, Italy
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Khairat S, Yao Y, Coleman C, McDaniel P, Edson B, Shea CM. Changes in Patient Characteristics and Practice Outcomes of a Tele-Urgent Care Clinic Pre- and Post-COVID-19 Telehealth Policy Expansions. PERSPECTIVES IN HEALTH INFORMATION MANAGEMENT 2022; 19:1k. [PMID: 35692856 PMCID: PMC9123528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION The coronavirus 2019 pandemic (COVID-19) has resulted in major changes in lifestyle practices and healthcare delivery. The goal of this study was to examine changes in practice and service outcomes in a telehealth program before and after the federal and private telehealth policy expansion during the COVID-19 pandemic. These findings are particularly useful to understand what may be needed to overcome telehealth challenges in future disasters. METHODS We conducted a cross-sectional analysis of virtual visits through a statewide telehealth center embedded in a large academic healthcare system. Primary outcomes of this study were changes in telehealth visits pre- and post-policy expansions among at-risk populations. RESULTS A total of 2,132 telehealth visits were conducted: 1,530 (71.8 percent) patients were female, 1,561 (73.2 percent) were between the ages 18-50, 1,576 (74 percent) were uninsured, and 1,225 (57.5 percent) were from rural regions. The average number of telehealth visits per day increased from 14 to 33 visits post-expansion. A significant change in patient characteristics was found among senior, uninsured, and rural patients after the telehealth expansion.There was an 11 percent decrease in telehealth visits from very high vulnerability regions post-expansion compared to pre-expansion. There was a 15 percent decrease in visits resulting in prescription post-expansion (p-value<0.01). CONCLUSIONS COVID-19 policy expansions expanded telehealth utilization among at-risk populations such as senior, uninsured, and rural patients while decompressing hospitals and emergency rooms and maintaining positive patient experiences. Further regulations are needed around virtual visits unintended consequences, software certification, and guidelines for workforce training.
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Li MM, Rising KL, Goldberg EM. Transitioning to Telehealth? A Guide to Evaluating Outcomes. HEALTH POLICY AND TECHNOLOGY 2022; 11:100623. [PMID: 35369128 PMCID: PMC8957891 DOI: 10.1016/j.hlpt.2022.100623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives Methods Results Conclusions Public Interest Summary
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17
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Ziade N, Hmamouchi I, El Kibbi L, Daou M, Abdulateef N, Abutiban F, Elzorkany B, Dahou-Makhloufi C, Hamdi W, Al Emadi S, Halabi H, Alnaqbi KA, Abu Al Saoud S, Hashad S, Niamane R, El Rakawi M, Kazkaz L, Saad S, Eissa M, Fraser I, Masri B. Telehealth in rheumatology: the 2021 Arab League of Rheumatology Best Practice Guidelines. Rheumatol Int 2022; 42:379-390. [PMID: 34993578 PMCID: PMC8735733 DOI: 10.1007/s00296-021-05078-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 12/23/2021] [Indexed: 12/14/2022]
Abstract
To develop Best Practice Guidelines (BPG) for the use of Telehealth in Rheumatology in the Arab region, to identify the main barriers and facilitators of telehealth, and to provide rheumatologists with a practical toolkit for the implementation of telehealth. Guidelines were drafted by a core steering committee from the Arab League of Associations for Rheumatology (ArLAR) after performing a literature search. A multidisciplinary task force (TF), including 18 rheumatologists, 2 patients, and 2 regulators from 15 Arab countries, assessed the BPG using 3 rounds of anonymous online voting by modified Delphi process. The statements were included in the final BPG without further voting if ≥ 80% of TF members indicated high agreement. The voting on barriers and facilitators was performed through one voting round. The toolkit was developed based on available literature and discussions during the Delphi rounds. Four General Principles and twelve Statements were formulated. A teleconsultation was specifically defined for the purpose of these guidelines. The concept of choice in telehealth was highlighted, emphasizing patient confidentiality, medical information security, rheumatologist's clinical judgment, and local jurisdictional regulations. The top barrier for telehealth was the concern about the quality of care. The toolkit emphasized technical aspects of teleconsultation and proposed a triage system. The ArLAR BPG provide rheumatologists with a series of strategies about the most reliable, productive, and rational approaches to apply telehealth.
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Affiliation(s)
- Nelly Ziade
- Rheumatology Department, Saint-Joseph Medical University, Beirut, Lebanon.
- Rheumatology Department, Hotel-Dieu de France Hospital, Alfred Naccache Blvd. Achrafieh, Beirut, Lebanon.
| | - Ihsane Hmamouchi
- Rheumatology Unit, Laboratory of Biostatistics, Clinical Research and Epidemiology (LBRCE), Temara Hospital, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Lina El Kibbi
- Rheumatology Division, Department of Internal Medicine, Specialized Medical Center, Riyadh, Saudi Arabia
| | - Melissa Daou
- Medicine Department, Faculty of Medicine, Saint-Joseph Medical University, Beirut, Lebanon
| | - Nizar Abdulateef
- Rheumatology Unit, Department of Medicine, College of Medicine, University of Baghdad, Baghdad, Iraq
| | - Fatemah Abutiban
- Rheumatology Unit, Department of Medicine, Jaber Alahmed Alsabah Hospital, Kuwait City, State of Kuwait
| | | | - Chafia Dahou-Makhloufi
- Rheumatolology Department, Mohamed Lamine Debaghine University Hospital, Bab El Oued, Algiers, Algeria
| | - Wafa Hamdi
- Rheumatology Department, Kassab Institute of Orthopedics, UR17SP04, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Samar Al Emadi
- Rheumatology Department, Hamad Medical Corporation, Doha, Qatar
| | - Hussein Halabi
- Rheumatology Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Khalid A Alnaqbi
- Rheumatology Department, Tawam Hospital, Al Ain, UAE
- Department of Internal Medicine, College of Medicine and Health Sciences, UAE University, Al Ain, UAE
| | - Sima Abu Al Saoud
- Rheumatology Department, Makassed Hospital, East Jerusalem, Palestine
| | - Soad Hashad
- Rheumatology Department, Tripoli Children Hospital, Tripoli, Libya
- Rheumatology Department, University of Tripoli, Tripoli, Libya
| | - Radouane Niamane
- Rheumatology Department, Avicenne Military Hospital, Cadi Ayyd University, Marrakech, Morocco
| | - Manal El Rakawi
- Rheumatology Department, Faculty of Medicine, Douera Hospital, Saad Dahlab, Blida, Algeria
| | - Layla Kazkaz
- Rheumatology Department, Teshreen Hospital and Syrian Medical Association, Damascus, Syria
| | - Sahar Saad
- Rheumatology Department, Assiut University, Asyut, Egypt
- Rheumatology Department, King Hamad University Hospital, Bahrain, Bahrain
| | - Mervat Eissa
- Rheumatology Department, Cairo University, Cairo, Egypt
| | | | - Basel Masri
- Rheumatology Division, Internal Medicine Department, Jordan Hospital, Amman, Jordan
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Nizeyimana E, Joseph C, Louw QA. A scoping review of feasibility, cost-effectiveness, access to quality rehabilitation services and impact of telerehabilitation: A review protocol. Digit Health 2022; 8:20552076211066708. [PMID: 35223074 PMCID: PMC8874157 DOI: 10.1177/20552076211066708] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 11/28/2021] [Indexed: 11/15/2022] Open
Abstract
Background Telerehabilitation is an emerging segment of telehealth and telemedicine that has a potential to deliver quality, accessible, cost-effective and efficient rehabilitation services where geographical distance is a critical factor. The objectives of this review are: to describe the feasibility and cost-effectiveness of telerehabilitation, to scope to what extent telerehabilitation has the potential impact on access to quality of rehabilitation services with specific references to low to middle income countries, and to understand key process factors including barriers and facilitators relevant to the implementation of telerehabilitation. Methods A scoping review of the literature will be conducted. An electronic search literature will be conducted in PubMed, Scopus, Cochrane library, Africa-wide information, CINAHL, MEDLINE, ProQuest, Web of science and reference lists. The review team will develop a data charting form and pilot it on four randomly-selected studies. The form will be refined based on the results of the piloted articles. Studies identified will be screened at the title and abstract levels by the first reviewer, followed by an independent verification for the accuracy and eligibility by two more reviewers prior to obtaining the full texts. Studies to be included must report on feasibility, cost-effectiveness, access to rehabilitation services, implementation process factors including barriers and facilitators of telerehabilitation. The analysis will include both descriptive summary and inductive thematic analysis. Conclusion Telerehabilitation has ability to change the current standard of care and allow for improved access and health outcomes in cost-effective ways, while addressing the scarce and unequal distribution of limited number of healthcare providers especially in low to middle income country settings. Thus, the research findings could be used by different stakeholders including: researchers, clinicians, policy makers, and implementation teams as they determine the appropriate setup for new telerehabilitation programs.
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Affiliation(s)
- Eugene Nizeyimana
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, South Africa
| | - Conran Joseph
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, South Africa
| | - Quinette A Louw
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, South Africa
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19
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Leone E, Eddison N, Healy A, Royse C, Chockalingam N. Exploration of implementation, financial and technical considerations within allied health professional (AHP) telehealth consultation guidance: a scoping review including UK AHP professional bodies' guidance. BMJ Open 2021; 11:e055823. [PMID: 34969656 PMCID: PMC8718347 DOI: 10.1136/bmjopen-2021-055823] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The COVID-19 pandemic has resulted in a shift to remote consultations, but telehealth consultation guidelines are lacking or inconsistent. Therefore, a scoping review was performed to chart the information in the articles exploring telehealth for the UK allied health professionals (AHPs) and compare them with the UK AHP professional bodies' guidelines. DESIGN Scoping review following Aksey and O' Malley methodological framework. DATA SOURCES CINHAL and MEDLINE were searched from inception to March 2021 using terms related to 'telehealth', 'guidelines' and 'AHPs'. Additionally, the UK AHP professional bodies were contacted requesting their guidelines. STUDY SELECTION Articles exploring telehealth for patient consultations, written in English and published in peer-reviewed journal or guidelines available from UK AHP professional bodies/their websites were considered eligible for review. DATA EXTRACTION One reviewer extracted data concerning three overarching domains: implementation, financial and technological considerations. RESULTS 2632 articles were identified through database searches with 21 articles eligible for review. Eight guidelines were obtained from the UK AHP professional bodies with a total of 29 included articles/guidelines. Most articles were published in the last two years; there was variety in telehealth terminology, and most were developed for occupational therapists, physiotherapists and speech and language therapists. Information was lacking about the assessment of telehealth use and effectiveness, barriers and limitations, the logistical management, the family's and caregiver's roles and the costs. There was lack of clarity on the AHPs' registration requirements, costs and coverage, and legal aspects. CONCLUSION This study identified gaps in current guidelines, which showed similarities as well as discrepancies with the guidance for non-AHP healthcare professionals and revealed that the existing guidelines do not adequately support AHPs delivering telehealth consultations. Future research and collaborative work across AHP groups and the world's leading health institutions are suggested to establish common guidelines that will improve AHP telehealth services.
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Affiliation(s)
- Enza Leone
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent, UK
| | - Nicola Eddison
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent, UK
- Orthotic Service, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Aoife Healy
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent, UK
| | - Carolyn Royse
- Dorset County Hospital NHS Foundation Trust, Dorchester, Dorset, UK
| | - Nachiappan Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent, UK
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20
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Anjum MR, Chalmers J, Hamid R, Rajoriya N. COVID-19: Effect on gastroenterology and hepatology service provision and training: Lessons learnt and planning for the future. World J Gastroenterol 2021; 27:7625-7648. [PMID: 34908803 PMCID: PMC8641058 DOI: 10.3748/wjg.v27.i44.7625] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 06/28/2021] [Accepted: 11/15/2021] [Indexed: 02/06/2023] Open
Abstract
In late 2019, reports arose of a new respiratory disease in China, identified as a novel coronavirus, severe acute respiratory syndrome coronavirus 2. The World Health Organisation named the disease caused by the virus 'coronavirus disease 2019 (COVID-19)'. It was declared a pandemic in early 2020, after the disease rapidly spread across the world. COVID-19 has not only resulted in substantial morbidity and mortality but also significantly impacted healthcare service provision and training across all medical specialties with gastroenterology and Hepatology services being no exception. Internationally, most, if not all 'non-urgent' services have been placed on hold during surges of infections. As a result there have been delayed diagnoses, procedures, and surgeries which will undoubtedly result in increased morbidity and mortality. Outpatient services have been converted to remote consultations where possible in many countries. Trainees have been redeployed to help care for COVID-19 patients in other settings, resulting in disruption to their training - particularly endoscopy and outpatient clinics. This has led to significant anxiety amongst trainees, and risks prolongation of training. It is of the utmost importance to develop strategies that continue to support COVID-19-related service provision, whilst also supporting existing and future gastroenterology and Hepatology services and training. Changes to healthcare provision during the pandemic have generated new and improved frameworks of service and training delivery, which can be adopted in the post-COVID-19 world, leading to enhanced patient care.
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Affiliation(s)
- Muhammad Raheel Anjum
- Department of Gastroenterology, The Royal Wolverhampton NHS Trust, Wolverhampton WV100QP, United Kingdom
| | - Jodie Chalmers
- Department of Medicine, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2WB, United Kingdom
| | - Rizwana Hamid
- Department of Gastroenterology, Royal Alexandria Hospital, Paisley PA2 9PJ, Scotland, United Kingdom
| | - Neil Rajoriya
- The Liver Unit, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2WB, United Kingdom
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TT, United Kingdom
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21
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Yim D, Chandra S, Sondh R, Thottarath S, Sivaprasad S. Barriers in establishing systematic diabetic retinopathy screening through telemedicine in low- and middle-income countries. Indian J Ophthalmol 2021; 69:2987-2992. [PMID: 34708733 PMCID: PMC8725078 DOI: 10.4103/ijo.ijo_1411_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Vision-threatening diabetic retinopathy (VTDR) is one of the leading causes of impaired vision in the working-age population. Early identification, timely diagnosis, and prompt treatment of VTDR have to be tackled simultaneously to reduce the rate of blindness due to this condition. Considerable emphasis has been placed globally on establishing diabetic retinopathy screening (DRS) programs to enable early identification and referral of VTDR for treatment. However, there is an urgent need to shift from the common practice of opportunistic screening to a systematic DRS pathway to ensure that individuals with diabetes are screened at regular intervals and treated appropriately. While systematic DRS programs have been successfully established in countries such as the United Kingdom (UK), it continues to be a challenge to initiate and sustain such programs in low- and middle-income countries (LMIC), home to approximately 80% of people with diabetes. Telemedicine is widely recognized as an ideal DRS screening program. Although it has resulted in an upsurge of opportunistic screening, systematic recall of screened patients remains a challenge. In addition, the link between referred patients from the telemedicine programs to treatment centers is often not established or has failed to deliver; so, there is minimal impact of these telemedicine programs on VTDR blindness at present. This review covers the various barriers of establishing and sustaining systematic telemedicine DRS programs, especially in resource-constrained settings, and the challenges in aligning telemedicine to VTDR treatment pathways to ensure patients with VTDR are treated promptly and effectively.
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Affiliation(s)
- Daniel Yim
- St. George's Medical School, University of London, London, UK
| | - Shruti Chandra
- University College London, Institute of Ophthalmology; NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, UK
| | - Rajan Sondh
- St. George's Medical School, University of London, London, UK
| | - Sridevi Thottarath
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, UK
| | - Sobha Sivaprasad
- University College London, Institute of Ophthalmology; NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, UK
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22
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Sun R, Blayney DW, Hernandez-Boussard T. Health management via telemedicine: Learning from the COVID-19 experience. J Am Med Inform Assoc 2021; 28:2536-2540. [PMID: 34459475 PMCID: PMC8499808 DOI: 10.1093/jamia/ocab145] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/09/2021] [Accepted: 06/30/2021] [Indexed: 11/26/2022] Open
Abstract
At the onset of the COVID-19 (coronavirus disease 2019) pandemic, telemedicine was rapidly implemented to protect patients and healthcare providers from infection. It is unlikely that care delivery will fully return to the pre-COVID form. Telemedicine offers many opportunities to improve care efficiency, accessibility, and patient outcomes, but many challenges exist related to technology interoperability, the digital divide, and usability. We propose that telemedicine evolve to support continuity of care throughout the patient journey, including multidisciplinary care teams and the seamless integration of data into the clinical workflow to support a learning healthcare system. Importantly, evidence is needed to support this paradigm shift in care delivery to ensure the quality and efficacy of care delivered via telemedicine. Here, we highlight gaps and opportunities that need to be addressed by the biomedical informatics community to move forward with safe and effective healthcare delivery via telemedicine.
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Affiliation(s)
- Ran Sun
- Department of Medicine, Stanford University, Stanford, California, USA
| | - Douglas W Blayney
- Stanford Cancer Institute, Stanford University, Stanford, California, USA
- Division of Medical Oncology, Department of Medicine, Stanford University, Stanford, California, USA
| | - Tina Hernandez-Boussard
- Department of Medicine, Stanford University, Stanford, California, USA
- Department of Biomedical Data Science, Stanford University, Stanford, California, USA
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23
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Zickuhr L, Kolfenbach J, Bolster MB. Applying Educational Theory to Optimize Trainee Education in the Ambulatory Virtual Care Environment. MEDICAL SCIENCE EDUCATOR 2021; 31:1715-1722. [PMID: 34422453 PMCID: PMC8370462 DOI: 10.1007/s40670-021-01365-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/30/2021] [Indexed: 05/10/2023]
Abstract
Virtual care (VC) encounters have become an essential part of outpatient clinical care. The theory of situated learning and legitimate peripheral participation posits that medical trainees learn best when they participate in authentic patient care experiences and engage effectively with their preceptors, members of the health care team, and the clinical learning environment. This theory can provide a framework from which to approach teaching in the VC setting, whereby preceptors may capitalize on the unique learning and assessment opportunities provided during VC encounters and optimize educational experiences for trainees as well as clinical outcomes for patients. In this monograph, we propose an approach grounded in situated learning and legitimate peripheral participation for teaching in the VC environment, particularly during real-time video visits.
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Affiliation(s)
- Lisa Zickuhr
- Department of Medicine, Washington University School of Medicine, St. Louis, MO USA
| | - Jason Kolfenbach
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO USA
| | - Marcy B. Bolster
- Department of Medicine, Massachusetts General Hospital, Boston, MA USA
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24
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To H, McMaster T, Stelmach W. Addressing telemedicine challenges for surgery clinics in the Post-COVID era. ANZ J Surg 2021; 91:1643-1644. [PMID: 34264549 PMCID: PMC8420328 DOI: 10.1111/ans.17089] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/05/2021] [Accepted: 07/06/2021] [Indexed: 01/23/2023]
Affiliation(s)
- Henry To
- Department of Surgery, Northern Health, Melbourne, Victoria, Australia.,School of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Victoria, Australia.,Department of Surgery, Werribee Mercy Health, Melbourne, Victoria, Australia
| | - Thomas McMaster
- School of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Victoria, Australia
| | - Wanda Stelmach
- Department of Surgery, Northern Health, Melbourne, Victoria, Australia
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25
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Rodler S, Schütz JM, Styn A, Weinhold P, Casucelli J, Eismann L, Bauer RM, Staehler M, Stief C, Buchner A, Mumm JN. Mapping Telemedicine in German Private Practice Urological Care: Implications for Transitioning beyond the COVID-19 Pandemic. Urol Int 2021; 105:650-656. [PMID: 33951666 PMCID: PMC8247820 DOI: 10.1159/000515982] [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: 01/15/2021] [Accepted: 02/22/2021] [Indexed: 11/19/2022]
Abstract
Background There are limited data on the use and concern of telemedicine among German urologists, and thus, there are no established guidelines for telemedical diagnosis, treatment, and prevention of urological indications. Methods An anonymized survey was conducted among German private practice urologists during the 2019 coronavirus disease (COVID-19) pandemic. The χ<sup>2</sup> test, Mann-Whitney U-test, and Kruskal-Wallis test were used for statistical analysis. Results 257 urologists were included in the final analysis. Thirty-five (14.0%) of urologists had used telemedicine as part of their consultation, and 221 (86.0%) had not used telemedicine. There was no difference between telemedicine adoption rates between rural and urban settings. Telemedicine users were significantly more satisfied with the information they had received regarding telemedicine issues. Users saw the greatest barrier to telemedicine that patients do not take up the offer of telemedicine. Nonusers were most concerned with unclear indications for telemedicine followed by lesser reimbursements during telemedicine than in-person visitations. Users were significantly more likely to use telemedicine beyond the COVID-19 pandemic. Urologists, who wanted to use the service in the future, wanted an active support by the German society of urology and guidelines for telemedicine. Last, users and nonusers preferred telemedicine for non-acute chronic diseases and follow-up visitations. Conclusion Despite the COVID-19 pandemic, telemedicine remains a rarely used service among German private practice urologists. Ultimately, to overcome the current challenges, urologists require an active support for the service through the German Society of Urology and telemedical guidelines.
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Affiliation(s)
- Severin Rodler
- Klinik und Poliklinik für Urologie, Klinikum der Universität München, Munich, Germany.,Arbeitsgruppe für Anwendung von künstlicher Intelligenz und digitalen Gesundheits-anwendungen in der Urologie, Klinikum der Universität München, Munich, Germany
| | - Julius M Schütz
- Klinik und Poliklinik für Urologie, Klinikum der Universität München, Munich, Germany
| | - Amelie Styn
- Klinik und Poliklinik für Urologie, Klinikum der Universität München, Munich, Germany
| | - Philipp Weinhold
- Klinik und Poliklinik für Urologie, Klinikum der Universität München, Munich, Germany
| | - Jozefina Casucelli
- Klinik und Poliklinik für Urologie, Klinikum der Universität München, Munich, Germany
| | - Lennert Eismann
- Klinik und Poliklinik für Urologie, Klinikum der Universität München, Munich, Germany
| | - Ricarda M Bauer
- Klinik und Poliklinik für Urologie, Klinikum der Universität München, Munich, Germany
| | - Michael Staehler
- Klinik und Poliklinik für Urologie, Klinikum der Universität München, Munich, Germany
| | - Christian Stief
- Klinik und Poliklinik für Urologie, Klinikum der Universität München, Munich, Germany
| | - Alexander Buchner
- Klinik und Poliklinik für Urologie, Klinikum der Universität München, Munich, Germany.,Arbeitsgruppe für Anwendung von künstlicher Intelligenz und digitalen Gesundheits-anwendungen in der Urologie, Klinikum der Universität München, Munich, Germany
| | - Jan-Niclas Mumm
- Klinik und Poliklinik für Urologie, Klinikum der Universität München, Munich, Germany.,Arbeitsgruppe für Anwendung von künstlicher Intelligenz und digitalen Gesundheits-anwendungen in der Urologie, Klinikum der Universität München, Munich, Germany
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26
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Pareyson D, Pantaleoni C, Eleopra R, De Filippis G, Moroni I, Freri E, Zibordi F, Bulgheroni S, Pagliano E, Sarti D, Silvani A, Grazzi L, Tiraboschi P, Didato G, Anghileri E, Bersano A, Valentini L, Piacentini S, Muscio C, Leonardi M, Mariotti C, Eoli M, Nuzzo S, Tagliavini F, Confalonieri P, De Giorgi F. Neuro-telehealth for fragile patients in a tertiary referral neurological institute during the COVID-19 pandemic in Milan, Lombardy. Neurol Sci 2021; 42:2637-2644. [PMID: 33929645 PMCID: PMC8086222 DOI: 10.1007/s10072-021-05252-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 04/10/2021] [Indexed: 12/20/2022]
Abstract
Background Lombardy was severely hit by the COVID-19 pandemic since February 2020 and the Health System underwent rapid reorganization. Outpatient clinics were stopped for non-urgent patients: it became a priority to manage hundreds of fragile neurological patients who suddenly had less reference points. In Italy, before the pandemic, Televisits were neither recognized nor priced. Methods At the Fondazione IRCCS Istituto Neurologico C. Besta, we reorganized outpatient clinics to deliver Neuro-telemedicine services, including Televisits and Teleneurorehabilitation, since March 2020. A dedicated Working Group prepared the procedure, tested the system, and designed satisfaction questionnaires for adults and children. Results After a pilot phase, we prepared a procedure for Telemedicine outpatient clinics which was approved by hospital directions. It included prescription, booking, consenting, privacy and data protection, secure connection with patients (Teams Microsoft 365), electronic report preparation and delivery, reporting, and accountability of the services. During the March–September 2020 period, we delivered 3167 Telemedicine services, including 1618 Televisits, to 1694 patients (972 adults, 722 children) with a wide range of chronic neurological disorders. We successfully administered different clinical assessment and scales. Satisfaction among patients and caregivers was very high. Conclusions During the dramatic emergency, we were able to take care of more than 1600 patients by organizing Neuro-telehealth in a few weeks, lessening the impact of the pandemic on fragile patients with chronic neurological disorders; this strategy is now stably embedded in our care pathways. In Italy, Telehealth is at present recognized and priced and is becoming a stable pillar of the health system.
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Affiliation(s)
- Davide Pareyson
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy. .,Rare Neurodegenerative and Neurometabolic Diseases Unit, Clinical Neurosciences Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy.
| | | | - Roberto Eleopra
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | | | - Isabella Moroni
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Elena Freri
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | | | - Sara Bulgheroni
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | | | - Daniela Sarti
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Antonio Silvani
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Licia Grazzi
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | | | - Giuseppe Didato
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Elena Anghileri
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Anna Bersano
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Laura Valentini
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | | | - Cristina Muscio
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | | | | | - Marica Eoli
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Sara Nuzzo
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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Chang K, Hung S, Hsueh S, Chao S, Huang W, Chen H, Jeng Y, Chen H, Hwang J, Liou H. Development of the
Houston–Apollo
model for older people living in remote areas in Taiwan. Geriatr Gerontol Int 2021; 21:299-305. [DOI: 10.1111/ggi.14130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 12/11/2020] [Accepted: 12/25/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Kai‐Chieh Chang
- Department of Neurology National Taiwan University Hospital Yunlin Taiwan
| | - Shou‐Hung Hung
- Department of Family Medicine National Taiwan University Hospital Yunlin Taiwan
| | - Sung‐Ju Hsueh
- Department of Neurology National Taiwan University Hospital Yunlin Taiwan
| | - Shiau‐Fang Chao
- Department of Social Work National Taiwan University Taipei Taiwan
| | - Wei‐Lieh Huang
- Department of Psychiatry National Taiwan University Hospital Yunlin Taiwan
| | - Hsin‐Shui Chen
- Department of Rehabilitation National Taiwan University Hospital Yunlin Taiwan
| | - Yachung Jeng
- Department of Internal Medicine National Taiwan University Hospital Yunlin Taiwan
- Institute of Epidemiology and Prevention Medicine, College of Public Health National Taiwan University Taipei Taiwan
| | - Hsiu‐Hsi Chen
- Institute of Epidemiology and Prevention Medicine, College of Public Health National Taiwan University Taipei Taiwan
| | - Juey‐Jen Hwang
- Department of Internal Medicine National Taiwan University Hospital Yunlin Taiwan
- Division of Cardiology, Department of Internal Medicine National Taiwan University Hospital Taipei Taiwan
| | - Horng‐Huei Liou
- Department of Neurology National Taiwan University Hospital Yunlin Taiwan
- Department of Neurology and Pharmacology, College of Medicine National Taiwan University Taipei Taiwan
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Intan Sabrina M, Defi IR. Telemedicine Guidelines in South East Asia-A Scoping Review. Front Neurol 2021; 11:581649. [PMID: 33519669 PMCID: PMC7838484 DOI: 10.3389/fneur.2020.581649] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 11/30/2020] [Indexed: 11/17/2022] Open
Abstract
Background: Telemedicine is a useful tool to deliver healthcare to communities in low- to high-income countries, especially in the coronavirus disease 2019 pandemic era. Guidelines on telemedicine would assist healthcare providers in delivering healthcare services based on local circumstances. Objective: To explore and compare guidelines on telehealth and telemedicine in South East Asian countries. Methods: Electronic databases such as Google, PubMed, and Cochrane reviews were searched for articles using keywords such as “telemedicine” OR “telehealth” OR “eHealth” OR “telemedis” AND “guidelines” AND “South East Asia” OR “Malaysia” OR “Singapore” OR “Indonesia” OR “Thailand” OR “Vietnam” published up to 2020. Inclusion criteria were full articles and gray materials (i.e., policy statements, advisories, blueprints, executive summaries, and circulars) related to telemedicine guidelines. No language restrictions were imposed. Only the first 100 Google searches were included for eligibility based on its relevance to telemedicine guidelines. Exclusion criteria were abstracts, duplicate publications, blogs, news articles, promotional brochures, conference proceedings, and telemedicine projects unrelated to telemedicine guidelines. Results: A total of 62,300 articles were identified through the search engines (Google 62,203, PubMed 77, and Cochrane 20) and six articles from additional sources. Sixty-eight full-text articles fulfilled the inclusion criteria, but only 24 articles contained some form of guidelines on telemedicine: Indonesia (nine), Malaysia (seven), Singapore (five), Thailand (two), and Vietnam (one). There were six laws, six advisory guidelines, five policy statements, and two circulars (regulations) issued by either the Ministry of Communication and Multimedia, Ministry of Health, or Medical Councils from the respective countries. Issues addressed were clinical governance (100%); information and communication technology infrastructure (83.3%); privacy, storage, and record-keeping (77.8%, respectively); ethics and legal (77.8%); security and safety (72.2%); definitions and applications of telemedicine (72.2%); confidentiality (66.7%); licensing (66.7%); identification (55.6%); cost of information and communication technology infrastructure (55.6%); reimbursement (16.7%); mobile applications (11.1%); and feedback and choices (5.6%). The Singapore National Telemedicine Guidelines contained the most domains compared with other guidelines from South East Asia. Conclusions: Although there can be no “one-size-fits-all” telemedicine guideline, there should be a comprehensive and universal telemedicine guideline for any country to adapt based on the local context. Details on patient-identification, data ownership, back-up, and disposal; transregional cybersecurity laws and ways to overcome the limitations of telemedicine compared with face-to-face consultations should be outlined clearly to ensure uniformity of telemedicine service and patient safety.
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Affiliation(s)
- Mohamad Intan Sabrina
- Neurorehabilitation Unit, Department of Rehabilitation Medicine, Hospital Rehabilitasi Cheras, Kuala Lumpur, Malaysia.,Tung Shin Hospital, Kuala Lumpur, Malaysia
| | - Irma Ruslina Defi
- Faculty of Medicine, Hasan Sadikin General Hospital, Universitas Padjadjaran, Bandung, Indonesia
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Abstract
The COVID-19 pandemic has highlighted the important role of telemedicine as a tool for safe healthcare delivery across the world. While its use was more common in the developed world, the developing world has also adopted this strategy. It is important to develop a clear process and contextual guidance for effective use of this strategy for better patient-doctor interaction and its role in teaching/learning of trainees.
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Affiliation(s)
- Munazza Asad
- Dr. Munazza Asad, Resident Year 3, Dept. of Family Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Nooresahar
- Dr. Noor-e-Sahar, Resident Year 4, Dept. of Family Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Saniya R Sabzwari
- Dr. Saniya Raghib Sabzwari, Associate Professor, Dept. of Family Medicine, Aga Khan University Hospital, Karachi, Pakistan
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James O, Akinboboye B, Okunade K, Adekunle A, Adeyemo W. Evaluation of the use and effectiveness of telemedicine among the health professionals during the COVID 19 lockdown period: A cross sectional study. JOURNAL OF CLINICAL SCIENCES 2021. [DOI: 10.4103/jcls.jcls_68_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Thiessen M, Soriano AM, Loewen HJ, Decker KM. Impact of Telemedicine Use by Oncology Physicians on the Patient and Informal Caregiver Experience of Receiving Care: Protocol for a Scoping Review in the Context of COVID-19. JMIR Res Protoc 2020; 9:e25501. [PMID: 33290243 PMCID: PMC7744149 DOI: 10.2196/25501] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 11/23/2020] [Accepted: 12/01/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND During the COVID-19 pandemic, the use of telemedicine by oncology physicians in Manitoba, Canada, has increased to limit the risk of exposure to the virus for both patients and health care providers. It is not clear how telemedicine impacts the information needs of patients or the experience of receiving cancer care. OBJECTIVE The objective of this study is to describe how the use of telemedicine impacts the information needs and experience of patients with cancer and their informal caregivers (ie, family and friends) and identify directions for future research. METHODS This review will include all studies addressing telemedicine in the cancer context including those using quantitative, qualitative, and mixed methods approaches. This scoping review will be conducted using the methodology described by the Joanna Briggs Institute. In collaboration with a librarian scientist specializing in health sciences, a comprehensive search will be undertaken to identify and retrieve relevant reports published in English from 1990 to the present. Databases searched will include MEDLINE, CINAHL, EMBASE, Scopus, Cochrane Library, and PsycINFO. Data will be extracted by two independent reviewers, synthesized, and reported in a summary table and in a narrative format describing what has been reported regarding the impact of telemedicine by physicians in oncology on the experience of patients and their informal caregivers and their receipt of information. RESULTS The results from this scoping review are expected to be available by late spring 2021. CONCLUSIONS The results from this scoping review will be useful for informing practice as well as directing future research, both in the context of COVID-19 and beyond. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/25501.
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Affiliation(s)
- Maclean Thiessen
- Research Institute of Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB, Canada.,Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | - Andrea Michelle Soriano
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Hal John Loewen
- Neil John Maclean Health Science Library, University of Manitoba, Winnipeg, MB, Canada
| | - Kathleen Margaret Decker
- Research Institute of Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB, Canada.,Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
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Cui F, Ma Q, He X, Zhai Y, Zhao J, Chen B, Sun D, Shi J, Cao M, Wang Z. Implementation and Application of Telemedicine in China: Cross-Sectional Study. JMIR Mhealth Uhealth 2020; 8:e18426. [PMID: 33095175 PMCID: PMC7647817 DOI: 10.2196/18426] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 08/29/2020] [Accepted: 10/02/2020] [Indexed: 12/21/2022] Open
Abstract
Background Telemedicine has been used widely in China and has benefited a large number of patients, but little is known about the overall development of telemedicine. Objective The aim of this study was to perform a national survey to identify the overall implementation and application of telemedicine in Chinese tertiary hospitals and provide a scientific basis for the successful expansion of telemedicine in the future. Methods The method of probability proportionate to size sampling was adopted to collect data from 161 tertiary hospitals in 29 provinces, autonomous regions, and municipalities. Charts and statistical tests were applied to compare the development of telemedicine, including management, network, data storage, software and hardware equipment, and application of telemedicine. Ordinal logistic regression was used to analyze the relationship between these factors and telemedicine service effect. Results Approximately 93.8% (151/161) of the tertiary hospitals carried out telemedicine services in business-to-business mode. The most widely used type of telemedicine network was the virtual private network with a usage rate of 55.3% (89/161). Only a few tertiary hospitals did not establish data security and cybersecurity measures. Of the 161 hospitals that took part in the survey, 100 (62.1%) conducted remote videoconferencing supported by hardware instead of software. The top 5 telemedicine services implemented in the hospitals were teleconsultation, remote education, telediagnosis of medical images, tele-electrocardiography, and telepathology, with coverage rates of 86.3% (139/161), 57.1% (92/161), 49.7% (80/161), 37.9% (61/161), and 33.5% (54/161), respectively. The average annual service volume of teleconsultation reached 714 cases per hospital. Teleconsultation and telediagnosis were the core charging services. Multivariate analysis indicated that the adoption of direct-to-consumer mode (P=.003), support from scientific research funds (P=.01), charging for services (P<.001), number of medical professionals (P=.04), network type (P=.02), sharing data with other hospitals (P=.04), and expertise level (P=.03) were related to the effect of teleconsultation. Direct-to-consumer mode (P=.01), research funding (P=.01), charging for services (P=.01), establishment of professional management departments (P=.04), and 15 or more instances of remote education every month (P=.01) were found to significantly influence the effect of remote education. Conclusions A variety of telemedicine services have been implemented in tertiary hospitals in China with a promising prospect, but the sustainability and further standardization of telemedicine in China are still far from accomplished.
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Affiliation(s)
- Fangfang Cui
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.,National Telemedicine Center of China, Zhengzhou, Henan, China
| | - Qianqian Ma
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.,National Telemedicine Center of China, Zhengzhou, Henan, China
| | - Xianying He
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.,National Telemedicine Center of China, Zhengzhou, Henan, China
| | - Yunkai Zhai
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.,National Telemedicine Center of China, Zhengzhou, Henan, China.,School of Management Engineering, Zhengzhou University, Zhengzhou, Henan, China
| | - Jie Zhao
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.,National Telemedicine Center of China, Zhengzhou, Henan, China
| | - Baozhan Chen
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.,National Telemedicine Center of China, Zhengzhou, Henan, China
| | - Dongxu Sun
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.,National Telemedicine Center of China, Zhengzhou, Henan, China
| | - Jinming Shi
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.,National Telemedicine Center of China, Zhengzhou, Henan, China
| | - Mingbo Cao
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.,National Telemedicine Center of China, Zhengzhou, Henan, China
| | - Zhenbo Wang
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.,National Telemedicine Center of China, Zhengzhou, Henan, China
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Mahoney MF. Telehealth, Telemedicine, and Related Technologic Platforms: Current Practice and Response to the COVID-19 Pandemic. J Wound Ostomy Continence Nurs 2020; 47:439-444. [PMID: 32970029 PMCID: PMC7722284 DOI: 10.1097/won.0000000000000694] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Providing health care at a distance has evolved over the past decades, resulting in a myriad of terms and styles of care delivery. Telehealth is defined as any health care service delivered at a distance. Nursing services have been delivered by a wide range of specialty nurses for many years using various technological formats. Clinical experience suggests that few WOC nurses had extensively adopted these technologies and principles into their practice as recently as 2019. However, the COVID-19 pandemic of 2020 has forced both administrators and clinicians to rapidly adapt or introduce telemedicine technologies to deliver specialty care including WOC nurse services. CASES Three WOC nurses were chosen to describe the use of telehealth technologies to illustrate opportunities for WOC nurses to integrate telehealth nursing into a health care setting. Two adapted telehealth technology into their practice before the pandemic, and one started telehealth practice as a means to provide care after the onset of the pandemic. Disadvantages and advantages are discussed to provide further information regarding WOC patient care using these technologies. CONCLUSION The pandemic crisis has accelerated the need for health care to reimagine the delivery of care to patients. Telehealth technologies and principles have emerged as essential for WOC nurses to deliver safe and effective care.
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Affiliation(s)
- Mary F. Mahoney
- Mary F. Mahoney, MSN, RN, CWOCN, CFCN, UnityPoint at Home, West Des Moines, Iowa; WEB WOC Nursing Education Programs, Adjunct Faculty
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Singh AK, Kasle DA, Jiang R, Sukys J, Savoca EL, Z Lerner M, Kohli N. A Review of Telemedicine Applications in Otorhinolaryngology: Considerations During the Coronavirus Disease of 2019 Pandemic. Laryngoscope 2020; 131:744-759. [PMID: 32942340 PMCID: PMC7537247 DOI: 10.1002/lary.29131] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/03/2020] [Accepted: 09/11/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE/HYPOTHESIS Review the published literature of telemedicine's use within otorhinolaryngology (ORL), highlight its successful implementation, and document areas with need of future research. STUDY DESIGN State of the Art Review. METHODS Three independent, comprehensive searches for articles published on the subject of telemedicine in ORL were conducted of literature available from January 2000 to April 2020. Search terms were designed to identify studies which examined telemedicine use within ORL. Consensus among authors was used to include all relevant articles. RESULTS While several, small reports document clinical outcomes, patient satisfaction, and the cost of telemedicine, much of the literature on telemedicine in ORL is comprised of preliminary, proof-of-concept reports. Further research will be necessary to establish its strengths and limitations. CONCLUSIONS Particularly during the coronavirus disease of 2019 pandemic, telemedicine can, and should, be used within ORL practice. This review can assist in guiding providers in implementing telemedicine that has been demonstrated to be successful, and direct future research. Laryngoscope, 131:744-759, 2021.
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Affiliation(s)
- Amrita K Singh
- Division of Otolaryngology, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, U.S.A
| | - David A Kasle
- Division of Otolaryngology, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, U.S.A
| | - Roy Jiang
- Division of Otolaryngology, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, U.S.A
| | - Jordan Sukys
- Division of Otolaryngology, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, U.S.A
| | - Emily L Savoca
- Division of Otolaryngology, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, U.S.A
| | - Michael Z Lerner
- Division of Otolaryngology, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, U.S.A
| | - Nikita Kohli
- Division of Otolaryngology, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, U.S.A
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Emerick T, Alter B, Jarquin S, Brancolini S, Bernstein C, Luong K, Morrisseyand S, Wasan A. Telemedicine for Chronic Pain in the COVID-19 Era and Beyond. PAIN MEDICINE 2020; 21:1743-1748. [PMID: 32914858 PMCID: PMC7543644 DOI: 10.1093/pm/pnaa220] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Trent Emerick
- Department of Anesthesiology and Perioperative Medicine, Chronic Pain Division, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
- Correspondence to: Trent Emerick, MD, MBA, Department of Anesthesiology and Perioperative Medicine, Division of Chronic Pain, University of Pittsburgh Medical Center, Falk Medical Building – 6th floor, 3601 Fifth Avenue, Pittsburgh, PA 15213, USA. Tel: 412-692-2234; Fax: 412-692-2235; E-mail:
| | - Benedict Alter
- Department of Anesthesiology and Perioperative Medicine, Chronic Pain Division, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Susan Jarquin
- Department of Anesthesiology and Perioperative Medicine, Chronic Pain Division, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Scott Brancolini
- Department of Anesthesiology and Perioperative Medicine, Chronic Pain Division, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Cheryl Bernstein
- Department of Anesthesiology and Perioperative Medicine, Chronic Pain Division, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Kevin Luong
- Department of Anesthesiology and Perioperative Medicine, Chronic Pain Division, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Shannon Morrisseyand
- Department of Anesthesiology and Perioperative Medicine, Chronic Pain Division, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Ajay Wasan
- Department of Anesthesiology and Perioperative Medicine, Chronic Pain Division, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
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Required Data Elements and Requirements of a Teleoncology System to Provide Treatment Plans for Patients with Breast Cancer. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2020. [DOI: 10.5812/ijcm.100522] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background: Teleoncology refers to the use of telemedicine for remotely providing multiple specialized services in clinical oncology processes, including screening, diagnosis, treatment planning, consultation, supportive care, pathology, surgery, and follow-up services. Objectives: The aim of this study was to identify the required data elements and elicitation of requirements for developing a telemedicine system that aims at providing treatment plans for patients with breast cancer. Methods: In this study, the required data elements for the teleoncology system were identified through both the investigation of clinical guidelines and review of patients’ medical records. Identified data elements were determined by breast cancer specialists through the questionnaire. Besides, an interview method was applied to elicit the requirements of this system. Results: The identified data elements were categorized into 20 groups (e.g., clinical data, breast physical examinations, pathological results, tests, imaging results, etc.). From the 182 data elements included within the questionnaire, 125 were recognized to be necessary (n = 32, 100%). The lowest mean percentage were observed in magnesium blood test (Mg) (n = 21, 65.63%) and protein test (Pr) (n = 21, 65.63%). Other data elements with a minimum mean of 71.87% and a maximum mean of 100% were recognized necessary. In general, 2 major themes, 9 categories, and 45 related sub-categories were extracted from analyzing the findings of the interviews related to the system requirements. Conclusions: The findings of the present study can be used as a basis for developing teleoncology systems that aim at providing treatment plans for patients with breast cancer.
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Emerick T, Alter B, Jarquin S, Brancolini S, Bernstein C, Luong K, Morrisseyand S, Wasan A. Telemedicine for Chronic Pain in the COVID-19 Era and Beyond. PAIN MEDICINE (MALDEN, MASS.) 2020. [PMID: 32914858 DOI: 10.1093/pm/pnaa220.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Trent Emerick
- Department of Anesthesiology and Perioperative Medicine, Chronic Pain Division, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Benedict Alter
- Department of Anesthesiology and Perioperative Medicine, Chronic Pain Division, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Susan Jarquin
- Department of Anesthesiology and Perioperative Medicine, Chronic Pain Division, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Scott Brancolini
- Department of Anesthesiology and Perioperative Medicine, Chronic Pain Division, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Cheryl Bernstein
- Department of Anesthesiology and Perioperative Medicine, Chronic Pain Division, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Kevin Luong
- Department of Anesthesiology and Perioperative Medicine, Chronic Pain Division, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Shannon Morrisseyand
- Department of Anesthesiology and Perioperative Medicine, Chronic Pain Division, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Ajay Wasan
- Department of Anesthesiology and Perioperative Medicine, Chronic Pain Division, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
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Jenkins J, Oyama O. Telemedicine: The art of innovative technology in family medicine. Int J Psychiatry Med 2020; 55:341-348. [PMID: 32883143 DOI: 10.1177/0091217420951038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Technology in medicine has been rapidly evolving over the past decade, greatly improving the quality and types of services providers can offer to patients. Physicians in training are eager to embrace these novel innovations, and medical school and residency educators strive to offer learning experiences of a high standard that are relevant. One example of an emerging healthcare innovation is telemedicine, which permits the provision of medical care to patients away from clinics and hospitals, bringing patient-centered care to the patient. It has proven to be cost-effective, improve health outcomes, and enhance patient satisfaction. This article describes the development and structure of our family medicine residency program's telemedicine curriculum, first created in 2016 in response to the growing demand for this type of healthcare delivery model. There is discussion about the history of telemedicine, and about what contributed to its growth. A timeline of the steps taken to create our new telemedicine residency curriculum is reviewed, along with the key components that contributed to its success. The Lessons Learned section provides other educators insight into the strengths and opportunities revealed during the creation of the curriculum, and guidance on how the curriculum could be further enhanced.
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Affiliation(s)
- Julia Jenkins
- USF-MPM Family Medicine Residency, Clearwater, FL, USA
| | - Oliver Oyama
- USF-MPM Family Medicine Residency, Clearwater, FL, USA
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Keefe DT, Rickard M, Anderson P, Bagli D, Blais AS, Bolduc S, Braga LH, Brownrigg N, Chua M, Dave S, dos Santos J, Guerra L, Hayashi AH, Keays MA, Kim S, Koyle MA, Lee LC, Lorenzo AJ, MacLellan D, MacDonald L, MacNeily AE, Metcalfe PD, Moore K, Romao RL, Wang PZ. Prioritization and management recommendations of pediatric urology conditions during the COVID-19 pandemic. Can Urol Assoc J 2020; 14:E237-E250. [PMID: 32525802 PMCID: PMC7654666 DOI: 10.5489/cuaj.6693] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Daniel T. Keefe
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Mandy Rickard
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Peter Anderson
- Division of Pediatric Urology, IWK Health Centre, Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Darius Bagli
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Anne-Sophie Blais
- Division d’Urologie, Département de Chirurgie, CHU de Québec, Quebec City, QC, Canada
| | - Stéphane Bolduc
- Division d’Urologie, Département de Chirurgie, CHU de Québec, Quebec City, QC, Canada
| | - Luis H. Braga
- Department of Surgery/Urology, McMaster University, Hamilton, ON, Canada
| | - Natasha Brownrigg
- Department of Surgery/Urology, McMaster University, Hamilton, ON, Canada
| | - Michael Chua
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Sumit Dave
- Department of Surgery, Division of Urology, Western University, London, ON, Canada
| | - Joana dos Santos
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Luis Guerra
- Department of Surgery, Division of Pediatric Urology, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Allen H. Hayashi
- Division of Pediatric Surgery, Department of Surgery, Victoria General Hospital, Victoria, BC, Canada
| | - Mélise A. Keays
- Department of Surgery, Division of Pediatric Urology, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Soojin Kim
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Martin A. Koyle
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Linda C. Lee
- Division of Pediatric Surgery, Department of Surgery, Victoria General Hospital, Victoria, BC, Canada
| | - Armando J. Lorenzo
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Dawn MacLellan
- Division of Pediatric Urology, IWK Health Centre, Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Landan MacDonald
- Division of Pediatric Urology, IWK Health Centre, Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Andrew E. MacNeily
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Peter D. Metcalfe
- Department of Surgery, Division of Pediatric Surgery, University of Alberta, Stollery Children’s Hospital, Edmonton, AB, Canada
| | - Katherine Moore
- Division d’Urologie, Département de Chirurgie, CHU de Québec, Quebec City, QC, Canada
| | - Rodrigo L.P. Romao
- Division of Pediatric Urology, IWK Health Centre, Department of Urology, Dalhousie University, Halifax, NS, Canada
- Division of Pediatric Surgery, IWK Health Centre, Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Peter Z.T. Wang
- Department of Surgery, Division of Urology, Western University, London, ON, Canada
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Krznarić Ž, Bender DV, Laviano A, Cuerda C, Landi F, Monteiro R, Pirlich M, Barazzoni R. A simple remote nutritional screening tool and practical guidance for nutritional care in primary practice during the COVID-19 pandemic. Clin Nutr 2020; 39:1983-1987. [PMID: 32425292 PMCID: PMC7227572 DOI: 10.1016/j.clnu.2020.05.006] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 05/08/2020] [Indexed: 12/15/2022]
Abstract
Challenging periods like the COVID-19 pandemic require fast and efficient adaptations of the healthcare system. It is vital that every patient has access to nutritional care as a part of primary healthcare services, even if social distancing measures are adopted. Therefore, we propose a simple remote nutritional screening tool and practical guidance for nutritional care in primary practice, and their implementation into telemedicine processes and digital platforms suitable for healthcare providers. The acronym for the tool is R-MAPP, as for Remote – Malnutrition APP, while the tool will be available also as an app. This protocol consists of two simple validated clinical tools for identifying nutritional risk and loss of muscle mass and function –Malnutrition Universal Screening Tool (‘MUST’) and SARC-F (5-item questionnaire: Strength, Assistance with walking, Rise from a chair, Climb stairs and Falls) - and additional practical guidance on nutritional interventions for family physicians.
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Affiliation(s)
- Željko Krznarić
- Department of Gastroenterology, Hepatology and Nutrition, University Hospital Centre, University of Zagreb, Croatia.
| | - Darija Vranešić Bender
- Department of Gastroenterology, Hepatology and Nutrition, University Hospital Centre, University of Zagreb, Croatia
| | - Alessandro Laviano
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Cristina Cuerda
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Francesco Landi
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Catholic University, Rome, Italy
| | - Rosario Monteiro
- Department of Biomedicine, Biochemistry Unit, Faculty of Medicine, University of Porto, Al. Prof. Hernâni Monteiro, Porto, Portugal
| | - Matthias Pirlich
- Imperial Oak Outpatient Clinic, Endocrinology, Gastroenterology & Clinical Nutrition, Berlin, Germany
| | - Rocco Barazzoni
- Department of Medical, Surgical and Health Sciences, University of Trieste, Italy
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42
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Foong HF, Kyaw BM, Upton Z, Tudor Car L. Facilitators and barriers of using digital technology for the management of diabetic foot ulcers: A qualitative systematic review. Int Wound J 2020; 17:1266-1281. [PMID: 32390305 PMCID: PMC7948580 DOI: 10.1111/iwj.13396] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 04/22/2020] [Accepted: 04/26/2020] [Indexed: 02/06/2023] Open
Abstract
The use of digital technology has been shown to be effective in managing chronic conditions. Telemedicine and mobile application are two common applications of digital technology in managing diabetic foot ulcers (DFU). The facilitators and barriers of using it for DFU management are yet to be explored. This is a qualitative systematic review. Five bibliography databases and grey literature sources were searched (2000‐2019). Two reviewers independently screened the citations, extracted the data, assessed the quality of the included studies, and performed thematic synthesis. Three studies on patients and five studies on healthcare practitioners (HCPs) were included. Two studies focused on the use of mobile applications and six on telemedicine. In studies on patients, four analytical themes were generated: the relationships with HCPs; the attitude towards the usage of digital technology; the role of wound image taking; and impact of digital technology on DFU care, encompassing 15 facilitators (eg, enabling community support, improving wound care knowledge) and 12 barriers (eg, lack of technological savviness, difficulty reading on smartphones). Three analytical themes were generated from studies on HCPs: the impact of digital technology on HCPs; the role of digital technology in DFU care; and organisation of DFU care delivery, encompassing 17 facilitators (eg, adequate wound care training, digital technology enables holistic care) and 16 barriers (eg, lack of multidisciplinary approach in caring for DFU, lack of direct contact in care provision). Patients and HCPs reported various barriers and facilitators relating to different aspects of using digital technology in DFU management. Our findings can help inform future research as well as the adoption of digital technology in DFU management.
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Affiliation(s)
- Hui Foh Foong
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
| | - Bhone Myint Kyaw
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
| | - Zee Upton
- Skin Research Institute of Singapore, Agency for Science, Technology and Research, Singapore
| | - Lorainne Tudor Car
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore.,Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
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Abbott LM, Miller R, Janda M, Bennett H, Taylor ML, Arnold C, Shumack S, Soyer HP, Caffery LJ. A review of literature supporting the development of practice guidelines for teledermatology in Australia. Australas J Dermatol 2020; 61:e174-e183. [PMID: 32232852 DOI: 10.1111/ajd.13249] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 11/11/2019] [Accepted: 01/12/2020] [Indexed: 01/18/2023]
Abstract
Despite the potential of teledermatology to increase access to dermatology services and improve patient care, it is not widely practised in Australia. In an effort to increase uptake of teledermatology, Australian-specific practice guidelines for teledermatology are being developed by the Australasian College of Dermatologist. This paper reports finding from literature reviews that were undertaken to inform the development of these guidelines. Results cover the following sections: Modalities of teledermatology; Patient selection and consent; Imaging; Quality and safety; Privacy and security; Communication; and Documentation and retention. The document educates providers about the benefits and limitations of telehealth while articulating how to enhance patient care and reduce risk when practicing teledermatology.
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Affiliation(s)
- Lisa M Abbott
- Sydney Law School, University of Sydney, Sydney, New South Wales, Australia.,The Australasian College of Dermatologists, Sydney, New South Wales, Australia
| | - Robert Miller
- The Australasian College of Dermatologists, Sydney, New South Wales, Australia
| | - Monika Janda
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Haley Bennett
- The Australasian College of Dermatologists, Sydney, New South Wales, Australia
| | - Monica L Taylor
- Centre for Online Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Chris Arnold
- The Australasian College of Dermatologists, Sydney, New South Wales, Australia.,Hodgson Associates, Melbourne, Victoria, Australia
| | - Stephen Shumack
- The Australasian College of Dermatologists, Sydney, New South Wales, Australia
| | - H Peter Soyer
- The University of Queensland Diamantina Institute, Brisbane, Queensland, Australia
| | - Liam J Caffery
- Centre for Online Health, The University of Queensland, Brisbane, Queensland, Australia
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Telehealth for Pediatric Cardiology Practitioners in the Time of COVID-19. Pediatr Cardiol 2020; 41:1081-1091. [PMID: 32656626 PMCID: PMC7354365 DOI: 10.1007/s00246-020-02411-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 07/03/2020] [Indexed: 01/18/2023]
Abstract
Due to the COVID-19 pandemic, there has been an increased interest in telehealth as a means of providing care for children by a pediatric cardiologist. In this article, we provide an overview of telehealth utilization as an extension of current pediatric cardiology practices and provide some insight into the rapid shift made to quickly implement these telehealth services into our everyday practices due to COVID-19 personal distancing requirements. Our panel will review helpful tips into the selection of appropriate patient populations and specific cardiac diagnoses for telehealth that put patient and family safety concerns first. Numerous practical considerations in conducting a telehealth visit must be taken into account to ensure optimal use of this technology. The use of adapted staffing and billing models and expanded means of remote monitoring will aid in the incorporation of telehealth into more widespread pediatric cardiology practice. Future directions to sustain this platform include the refinement of telehealth care strategies, defining best practices, including telehealth in the fellowship curriculum and continuing advocacy for technology.
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Cowan KE, McKean AJ, Gentry MT, Hilty DM. Barriers to Use of Telepsychiatry: Clinicians as Gatekeepers. Mayo Clin Proc 2019; 94:2510-2523. [PMID: 31806104 DOI: 10.1016/j.mayocp.2019.04.018] [Citation(s) in RCA: 214] [Impact Index Per Article: 42.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 04/15/2019] [Accepted: 04/24/2019] [Indexed: 12/17/2022]
Abstract
Telepsychiatry is effective and has generated hope and promise for improved access and enhanced quality of care with reasonable cost containment. Clinicians and organizations are informed about clinical, technological, and administrative telepsychiatric barriers via guidelines, but there are many practical patient and clinician factors that have slowed implementation and undermined sustainability. Literature describing barriers to use of telepsychiatry was reviewed. PubMed search terms with date limits from January 1, 1959, to April 25, 2019, included telepsychiatry, telemedicine, telemental health, videoconferencing, video based, Internet, synchronous, real-time, two-way, limitations, restrictions, barriers, obstacles, challenges, issues, implementation, utilization, adoption, perspectives, perceptions, attitudes, beliefs, willingness, acceptability, feasibility, culture/cultural, outcomes, satisfaction, quality, effectiveness, and efficacy. Articles were selected for inclusion on the basis of relevance. Barriers are described from both patient and clinicians' perspectives. Patients and clinicians are largely satisfied with telepsychiatry, but concerns about establishing rapport, privacy, safety, and technology limitations have slowed acceptance of telepsychiatry. Clinicians are also concerned about reimbursement/financial, legal/regulatory, licensure/credentialing, and education/learning issues. These issues point to system and policy concerns, which, in combination with other administrative concerns, raise questions about system design/workflow, efficiency of clinical care, and changing organizational culture. Although telepsychiatry service is convenient for patients, the many barriers from clinicians' perspectives are concerning, because they serve as gatekeepers for implementation and sustainability of telepsychiatry services. This suggests that solutions to overcome barriers must start by addressing the concerns of clinicians and enhancing clinical workflow.
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Affiliation(s)
- Kirsten E Cowan
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN; Essentia Health, Duluth, MN
| | | | - Melanie T Gentry
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Donald M Hilty
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento
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Haveman ME, Kleiss SF, Ma KF, Vos CG, Ünlü Ç, Schuurmann RCL, Bokkers RPH, Hermens HJ, De Vries JPPM. Telemedicine in patients with peripheral arterial disease: is it worth the effort? Expert Rev Med Devices 2019; 16:777-786. [PMID: 31379218 DOI: 10.1080/17434440.2019.1649595] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: For patients with peripheral arterial disease (PAD), the various components of telemedicine, such as telemonitoring, telecoaching, and teleconsultation, could be valuable in daily management. The objective of this review was to give an overview of the current use of telemedicine interventions in PAD. Areas covered: A literature search was performed for studies that evaluated patients with PAD of the aorto-pedal trajectory, who were monitored by telemedicine and acted upon accordingly. The primary outcome was health-related outcomes. The studies that were found focused mainly on wearable activity monitoring and telecoaching in PAD (n = 4) or wound monitoring after vascular surgery (n = 2). Main results indicate that telemedicine interventions are able to detect (post-operative) complications early, improve functional capacity and claudication onset time, and improve PAD patients' quality of life. Expert opinion: The use of telemedicine in PAD patients is still an under-explored area. Studies investigating the use of telemedicine in PAD are very limited and show varying results. Owing to its high potential in improving physical ability, lifestyle coaching, and timely detection of deterioration, future research should focus on proper implementation of telemedicine in PAD patients, including clinical and feasibility outcomes, effect on workload of nurses, and cost-efficiency.
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Affiliation(s)
- Marjolein E Haveman
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen , Groningen , The Netherlands
| | - Simone F Kleiss
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen , Groningen , The Netherlands
| | - Kirsten F Ma
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen , Groningen , The Netherlands
| | - Cornelis G Vos
- Department of Surgery, Martini Hospital , Groningen , The Netherlands
| | - Çağdaş Ünlü
- Department of Vascular Surgery, Northwest Clinics , Alkmaar , The Netherlands
| | - Richte C L Schuurmann
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen , Groningen , The Netherlands
| | - Reinoud P H Bokkers
- Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen , Groningen , The Netherlands
| | - Hermie J Hermens
- Department of Biomedical Signals and Systems, Telemedicine cluster, University of Twente , Enschede , the Netherlands
| | - Jean-Paul P M De Vries
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen , Groningen , The Netherlands
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Borzì L, Varrecchia M, Olmo G, Artusi CA, Fabbri M, Rizzone MG, Romagnolo A, Zibetti M, Lopiano L. Home monitoring of motor fluctuations in Parkinson’s disease patients. ACTA ACUST UNITED AC 2019. [DOI: 10.1007/s40860-019-00086-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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48
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Zhai Y, Gao J, Chen B, Shi J, Wang L, He X, Sun D, Chen H, Hou H, Song X, Zhao J. Design and Application of a Telemedicine System Jointly Driven by Videoconferencing and Data Exchange: Practical Experience from Henan Province, China. Telemed J E Health 2019; 26:89-100. [PMID: 31050599 DOI: 10.1089/tmj.2018.0240] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background and Objectives: There are a few problems restraining the effective operation of telemedicine in China. On the basis of practices of the Henan Province Telemedicine Center of China (HTCC), the purpose of this study was to design a telemedicine system jointly driven by videoconferencing and data exchange to address the issues limiting the further development and implementation of telemedicine. Methods: Based on service-oriented architecture, the organizational design of the telemedicine system was gradually refined from top to bottom to complete its hierarchical layout. Technologies including multiprotocol stack adaptation, self-adaptive multilink network transmission, information exchange of heterogeneous medical systems, and open application system architecture were also used to construct the system. Results: The telemedicine system realizes the integration of videoconferencing, data acquisition and exchange of heterogeneous medical information systems, and the actual applications and expansion of telemedicine services. The HTCC currently covers more than 500 telemedicine centers, workstations, and service points, forming a five-level "province-city-county-township-village" telemedicine network linkage. The HTCC handles nearly 30,000 teleconsultation cases per year, helping patients save about ¥120 million Chinese Yuan RMB (approximately US $17.5 million). Conclusions: The proposed telemedicine system achieves satisfactory operation effects, along with social and economic benefits. It has the potential to increase the coverage of medical resources in remote regions, and it can play a role in solving other problems facing telemedicine development in China. The findings also inform measures for further improvement in telemedicine's implementation effects, service quality, and application scope in China and globally.
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Affiliation(s)
- Yunkai Zhai
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,National Engineering Laboratory for Internet Medical Systems and Applications, Zhengzhou, China.,Henan Province Telemedicine Center of China, National Telemedicine Center of China, Zhengzhou, China.,Engineering Laboratory of Henan Province for Internet Medical E-commerce and Active Health Services, Zhengzhou University, Zhengzhou, China
| | - Jinghong Gao
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,National Engineering Laboratory for Internet Medical Systems and Applications, Zhengzhou, China.,Henan Province Telemedicine Center of China, National Telemedicine Center of China, Zhengzhou, China
| | - Baozhan Chen
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,National Engineering Laboratory for Internet Medical Systems and Applications, Zhengzhou, China.,Henan Province Telemedicine Center of China, National Telemedicine Center of China, Zhengzhou, China
| | - Jinming Shi
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,National Engineering Laboratory for Internet Medical Systems and Applications, Zhengzhou, China.,Henan Province Telemedicine Center of China, National Telemedicine Center of China, Zhengzhou, China
| | - Linlin Wang
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,National Engineering Laboratory for Internet Medical Systems and Applications, Zhengzhou, China.,Henan Province Telemedicine Center of China, National Telemedicine Center of China, Zhengzhou, China
| | - Xianying He
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,National Engineering Laboratory for Internet Medical Systems and Applications, Zhengzhou, China.,Henan Province Telemedicine Center of China, National Telemedicine Center of China, Zhengzhou, China
| | - Dongxu Sun
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,National Engineering Laboratory for Internet Medical Systems and Applications, Zhengzhou, China.,Henan Province Telemedicine Center of China, National Telemedicine Center of China, Zhengzhou, China
| | - Haotian Chen
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,National Engineering Laboratory for Internet Medical Systems and Applications, Zhengzhou, China.,Henan Province Telemedicine Center of China, National Telemedicine Center of China, Zhengzhou, China
| | - Hongli Hou
- Management Engineering School, Zhengzhou University, Zhengzhou, China
| | - Xiaoqin Song
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,National Engineering Laboratory for Internet Medical Systems and Applications, Zhengzhou, China.,Henan Province Telemedicine Center of China, National Telemedicine Center of China, Zhengzhou, China
| | - Jie Zhao
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,National Engineering Laboratory for Internet Medical Systems and Applications, Zhengzhou, China.,Henan Province Telemedicine Center of China, National Telemedicine Center of China, Zhengzhou, China
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Liu H, Xiao X, Lu CM, Ling DL, Wei RH. A systematic review of the effect of mobile health on cardiac rehabilitation among coronary heart disease patients. FRONTIERS OF NURSING 2018; 5:217-226. [DOI: 10.1515/fon-2018-0029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Abstract
Objective
Mobile health (mHealth) provides an innovative and effective approach to promote prevention and management of coronary heart disease. However, the magnitude of its effects is unclear. The aim of this systematic review was to examine the impact of mHealth-based cardiac rehabilitation outcomes among coronary heart disease patients.
Methods
Medline, CINAHL, Embase, PubMed, Google Scholar, NICE, and Cochrane library were searched for randomized controlled trials published between January 2002 and March 2017 which compared mHealth with conventional cardiac rehabilitation programs among coronary heart disease patients.
Results
Eight articles were included in this review. The impact of mHealth interventions on physical activity, medicine adherence, smoking cessation, level of anxiety, and quality of life was inconsistent among the articles.
Conclusions
Further research is needed to conclusively determine the impact of mHealth interventions on cardiac rehabilitation outcomes. The limitations of the included studies (e.g., inadequate sample size, failure to address the core components of cardiac rehabilitation programs, and lack of theory-based design) should be taken into account when designing future studies.
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Affiliation(s)
- Hui Liu
- Cardiac Intensive Care Unit (CCU), Department of Cardiology , The Second Affiliated Hospital of Shantou University Medical College , Shantou , Guangdong 515041 , China
| | - Xiao Xiao
- Obstetrics Department , Southern Medical University Affiliated Shenzhen Maternity and Child Healthcare Hospital , Guangzhou , Guangdong 510515 , China
| | - Chun-Mei Lu
- Department of Nursing , The First People's Hospital of Foshan Affiliated to Sun Yat-Sen University , Foshan , Guangdong 528000 , China
| | - Dong-Lan Ling
- Urology Surgical Department , The Second Affiliated Hospital of Guangzhou Medical University , Guangzhou , Guangdong 510260 , China
| | - Rui-Hong Wei
- Nursing Department , The Second Affiliated Hospital of Shantou University , Shantou , Guangdong 515041 , China
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50
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