International Journal of Telemedicine and Applications最新文献

Introduction: Amidst the COVID-19 pandemic, telehealth (TH) has gained increasing relevance in colorectal patient care, prompting an audit of the TH clinic at a tertiary colorectal unit. This study evaluated telephone-based consultations' clinical efficacy and diagnostic thresholds for new lower gastrointestinal (LGI) bleeding referrals. Methods: We conducted a quality assurance audit of the per rectal (PR) bleeding TH clinic at Northern Hospital Victoria, evaluating new LGI bleeding referrals. Data from July 2021 to June 2023 were extracted from the Referral Management System (RMS) and analyzed. The study focused on newly referred patients, excluding those previously seen or awaiting procedures. Clinical efficacy was determined through sensitivity, specificity, and predictive values, with a receiver operating characteristic (ROC) curve assessing the TH method's discrimination threshold. Results: Of the 239 patients, 131 met the inclusion criteria, with a compliance rate of 96%. The TH clinic demonstrated a sensitivity of 75.76% and specificity of 52.46% in distinguishing between colorectal and anal pathologies. The average time from referral to a diagnostic procedure was 9.75 weeks, with a reduction in median wait time for first appointments from 19 weeks prepandemic to 3.6 weeks. A cost-benefit analysis highlighted TH clinics' ability to reduce overhead costs and maintain a revenue stream despite reduced face-to-face consultations. Conclusion: Our study concludes that the telecare service model serves as an effective complementary approach for managing new LGI bleeding referrals. Further research on long-term outcomes and cost-effectiveness is necessary to fully assess telecare as a potentially sustainable hybrid model.

This study proposes an automated system for assessing lung damage severity in coronavirus disease 2019 (COVID-19) patients using computed tomography (CT) images. These preprocessed CT images identify the extent of pulmonary parenchyma (PP) and ground-glass opacity and pulmonary infiltrates (GGO-PIs). Two types of images-saliency (Q) image and discrete cosine transform (DCT) energy image-were generated from these images. A final fused (FF) image combining Q and DCT of PP and GGO-PI images was then obtained. Five convolutional neural networks (CNNs) and five classic classification techniques, trained using FF and grayscale PP images, were tested. Our study is aimed at showing that a CNN model, with preprocessed images as input, has significant advantages over grayscale images. Previous work in this field primarily focused on grayscale images, which presented some limitations. This paper demonstrates how optimal results can be obtained by using the FF image rather than just the grayscale PP image. As a result, CNN models outperformed traditional artificial intelligence classification techniques. Of these, Vgg16Net performed best, delivering top-tier classification results for COVID-19 severity assessment, with a recall rate of 95.38%, precision of 96%, accuracy of 95.84%, and area under the receiver operating characteristic (AUROC) curve of 0.9585; in addition, the Vgg16Net delivers the lowest false negative (FN) results. The dataset, comprising 44 COVID-19 patients, was split equally, with half used for training and half for testing.

Introduction: Telerobotic ultrasound has emerged as a promising technology in medicine, especially in settings with limited medical access or a lack of specialized personnel. However, there are very few studies evaluating its usefulness in real-world clinical practice. Objective: This study evaluates the usefulness of abdominopelvic telerobotic ultrasound in a real-world practice setting. Methods: A prospective study was performed in a cohort of adult patients who underwent abdominal ultrasound in a remote secondary hospital for suspected abdominal or pelvic pathology. Examinations were performed by an on-site technician and a remote abdominal radiologist. Satisfaction of patients and explorers, scan times, quality of visualization of anatomical structures, and ultrasound findings were measured and compared with standard ultrasound examinations performed by an on-site radiologist blinded to telerobotic ultrasound findings. Multivariate analyses were performed to predict variables related to the visualization quality of abdominopelvic organs. Results: The sample included 40 patients (60% women; mean age, 51.2 ± 16.1 years; 35% overweight and 17.5% obese). Significant differences in ultrasound duration were observed between telerobotic ultrasound and standard ultrasound (27.4 ± 8.3 and 12.7 ± 3.1 min, respectively; p < 0.001). The mean satisfaction of radiologists, technicians, and patients with telerobotic ultrasound was high (7.35 ± 1.14 for radiologists, 7.93 ± 0.83 for technicians, and 8.43 ± 1.38 for patients). Visualization of anatomical structures was acceptable for most organs on telerobotic ultrasound but significantly worse than conventional ultrasound when "excellent visualization" was the reference standard. In addition, telerobotic ultrasound did not identify potentially relevant findings in a significant (70%) proportion of patients. Conclusions: Telerobotic ultrasound offers acceptable results in the assessment of abdominopelvic organs and can help provide adequate healthcare to patients in locations with limited access to radiology specialists. However, there are significant limitations compared to standard ultrasound for their optimal evaluation.

Background: Telepharmacy is the delivery of pharmacy services through telecommunications technology when patients and pharmacists are separated by physical distance. Falling under the broader term of telehealth, telepharmacy has been adopted globally and proved invaluable during the COVID-19 pandemic. Objective: The study is aimed at investigating New Zealand pharmacists' perceptions of telepharmacy adoption and assessing its potential impact on their future scope of practice. Methods: New Zealand registered pharmacists were recruited through convenience sampling to participate in semistructured interviews conducted between July and August 2022. Interviews were transcribed and coded with NVivo and analyzed using inductive thematic analysis to develop themes. Themes and subthemes were mapped to the Clinical Adoption Framework (CAF) to interpret the findings. Results: From 23 participants, 70% were community pharmacists. The COVID-19 pandemic accelerated telepharmacy adoption in New Zealand and most pharmacists perceived it as convenient and beneficial to increase access to pharmacy services. Barriers such as the lack of resources, technology issues, inadequate remuneration, and existing legislation were highlighted, as was the need for better staff training, patient education, better access to technology, regulatory reforms, and integration with existing services. Conclusion: There is a need for reforms and initiatives for sustainable and equitable telehealth use in New Zealand. While preparing for digital infrastructure and capabilities presents challenges, this investment can transform pharmacy practice in the long term, benefiting both patients and pharmacy professionals.

Objectives: Telemedicine has emerged as a crucial tool in addressing public health requirements, particularly during a pandemic. This aligns with the third Sustainable Development Goals (SDGs) objective of ensuring healthy lives and promoting well-being for all ages. The current generation demonstrates a greater proficiency in modern technology, prompting researchers to investigate their views and behavior trends in telemedicine. Methods: This research is aimed at examining the telemedicine adoption patterns of Generation Y and Generation Z by dividing them into two groups. Study Group 1 is comprised of those who have known modern technology but have yet to gain experience in using telemedicine. Meanwhile, Study Group 2 is comprised of those who had used telemedicine services. Utilizing structural equation model (SEM) analysis, this research investigates the magnitude of influence exerted by various determinants on an individual's tendency to utilize telemedicine. Results: Findings from both study groups indicate that younger generations have positive attitudes towards telemedicine, significantly influencing their willingness to use telemedicine. Furthermore, the level of readiness for change emerges as a crucial factor in determining the degree of affective commitment to change, continuance commitment to change, and normative commitment to change. In addition, the participants' affective experience state significantly influences all three dimensions of commitment to change. Conclusion: The results suggest the importance of fostering a positive and pragmatic understanding of telemedicine among young people. This can be achieved by encouraging the use of telemedicine services and fully adopting the shift to telemedicine. Therefore, it is crucial to prioritize the development of a positive view towards telemedicine, provide excellent service experiences, and promote social flexibility to attract a large user base, especially among the younger population.

Cancer is the top cause of death worldwide, and machine learning (ML) has made an indelible mark on the field of early cancer detection, thereby lowering the death toll. ML-based model for cancer diagnosis is done using two forms of data: gene expression data and microarray data. The data on gene expression levels includes many dimensions. When dealing with data with a high dimension, the efficiency of an ML-based model is decreased. Microarray data is distinguished by its high dimensionality with a greater number of features and a smaller sample size. In this work, two ensemble techniques are proposed using majority voting technique and weighted average technique. Correlation feature selection (CFS) is used for feature selection, and improved grey wolf optimizer (IGWO) is used for feature optimization. Support vector machines (SVMs), multilayer perceptron (MLP) classification, logistic regression (LR), decision tree (DT), adaptive boosting (AdaBoost) classifier, extreme learning machines (ELMs), and K-nearest neighbor (KNN) are used as classifiers. The results of each distinct base learner were then combined using weighted average and majority voting ensemble methods. Accuracy (ACC), specificity (SPE), sensitivity (SEN), precision (PRE), Matthews correlation coefficient (MCC), and F1-score (F1-S) are used to assess the performance. Our result shows that majority voting achieves better performance than the weighted average ensemble technique.

The objectives of the present study were to analyze the adherence of normal weight and overweight/obese adolescents to intervention with mobile applications; to establish the differences in the evaluation of the mobile application and in the problematic use of the mobile phone between normal weight and overweight/obese adolescents; and to determine the relationship between the distance travelled, the evaluation of the mobile applications, and the conflictive use of the mobile phone. A quasi-experimental design was carried out with the participation of 70 adolescents between 12 and 16 years old (mean age: 14.25 ± 1.23 years old; 38 normal weight and 32 overweight/obese). The adolescents completed a 10-week intervention in which they used step tracker mobile applications for the promotion of physical activity, a minimum of three times per week. Problematic mobile phone use and adolescent ratings of the application used were measured. The results showed no significant differences in adolescents' adherence to the intervention according to the mobile application used (p = 0.191) or weight status (p = 0.202). In addition, significant differences were not found in the assessment of mobile applications within the group of overweight and obese adolescents: engagement (p = 0.471), functionality (p = 0.319), aesthetics (p = 0.378), information (p = 0.184), usability (p = 0.154), or perceived impact (p = 0.139), although differences were found in the assessment made by normal-weight adolescents in information (p = 0.029), usability (p = 0.029), and perceived impact (p = 0.044), where Pacer had better scores than Pokémon Go in the first two dimensions. No greater problematic mobile phone use was found after the intervention according to weight status (p = 0.311) nor the mobile application used (p = 0.985). It can be concluded that there is similar adherence among normal weight and overweight/obese adolescents to interventions with mobile applications to promote physical activity. It is noteworthy that adolescents, regardless of weight status, showed a positive perception towards the use of these mobile applications.

Background: The mental health service delivery gap remains high globally. Appropriate telehealth use may increase capacity through flexible remote care provision. Despite the historical lack of telehealth integration into publicly funded mental health services, during COVID-19 lockdowns, services rapidly switched to telephone and audiovisual care provision. In Aotearoa New Zealand (NZ), this was abandoned when no longer required by COVID-19 restrictions. This study explores environmental factors associated with telehealth implementation and ongoing use or discontinuation across a multiregional outpatient mental health service. This work contributes to understanding system-level factors influencing telehealth use and thus informs policy and practice in postpandemic environments. Methods: This mixed methods study applied an interpretive description methodology. Semistructured interviews with 33 mental health clinicians were thematically analysed. Qualitative findings were reframed and evaluated using time series analyses of population-level quantitative data (prior to and throughout the pandemic). Findings were synthesised with qualitative themes to develop an understanding of environmental factors contributing to telehealth use. Results: Findings highlighted an increase in clients assessed by mental health services and declining clinician numbers, contributing to pressure placed on clinicians. There was a lack of culture supporting telehealth, including limited awareness, leadership, and champions to facilitate implementation. Some teams provided services suited to telehealth; other subspeciality teams had limited applications for telehealth. There was a general lack of policy and guidelines to support telehealth use and limited technical support for clinicians unfamiliar with audiovisual software. Conclusion: Disorganised telehealth adoption in the study regions provides insight into wider environmental drivers affecting telehealth uptake. For telehealth to become a workable service delivery mode following COVID-19, stewardship and culture shifts are required, including policy development, technical support, and resources to support clinical teams. Telehealth may address growing service demand by improving interfaces with primary care and providing timely access to specialist input.

Background: Telepharmacy, utilizing telecommunications to dispense pharmaceutical products and deliver patient care, offers numerous benefits for both the public and pharmacists. Previous research on exploring attitudes and willingness to use telepharmacy services has primarily focused on pharmacists rather than the general population. Aim: This study is aimed at assessing the attitudes and willingness of the United Arab Emirates (UAE) population to utilize telepharmacy services and identifying the factors influencing their inclination to use these services. Methods: In this cross-sectional study, a survey was distributed using convenience and snowball sampling to individuals aged 18 or older across the UAE through various social media platforms, including Twitter, Facebook, and WhatsApp. The survey domains included sociodemographics, attitudes, and readiness to utilize a telepharmacy service. A binary logistic regression analysis was conducted to investigate the variables associated with participants' willingness to utilize telepharmacy in the future. Results: In total, 963 individuals participated in the study. Participants showed overall positive attitudes towards telepharmacy, with 70.9% believing that telepharmacy saved time and effort. While only 32% of the participants acknowledged that numerous telepharmacy services were available for use in the UAE, most were interested in using telepharmacy services in the future (79.2%). Participants who had higher attitude scores (AOR = 1.147, 95% confidence interval [CI]: 1.11-1.18) and those who had used these services previously (AOR = 3.270, 95% CI: 1.692-6.320) were more interested in using telepharmacy services in the future. Conclusion: Forthcoming healthcare strategies should focus on expanding the availability of telepharmacy services throughout various regions of the country. This expansion will facilitate the broader utilization of these services and ultimately contribute to improved health outcomes.

Introduction: The Virtual Clinic Mobile Application (VCMA) is a valuable tool for managing and remotely monitoring patients with various medical conditions. It can alleviate the strain on outpatient services and offer follow-up options for patients who do not require a physical examination. A thorough understanding of recent literature can assist in identifying suitable functionalities for new development and future improvement of current applications (apps). This review study is aimed at identifying functional and nonfunctional requirements for VCMA. Methods: This study conducted a systematic search using databases such as PubMed, Scopus, ISI Web of Science, Science Direct, ProQuest, and IEEE to gather requirements of VCMA articles published in English from the inception of the databases up to April 2022. Out of a total of 1223 articles, 76 met the inclusion criteria. These articles were then analyzed using conventional content analysis to extract and categorize their requirements. Results: Two main themes and 8 subthemes in terms of VCMA requirements were extracted as follows: (1) functional requirements with 3 subthemes (demographic data documentation, health record, general features of the user interface (UI)); (2) nonfunctional requirements with 5 subthemes (usability, accessibility, compatibility, efficiency, and security). Conclusion: The findings highlight the importance of mHealth solutions for virtual care and the need for the development of apps based on the extracted functional and nonfunctional requirements for VCMA; however, controlled trials are necessary. It is recommended that transparent reporting of mHealth interventions be prioritized to enable effective interpretation of the extracted data.